Der Schmerz
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Paraneoplastic syndromes (PS) are rare disorders with often complex clinical manifestations that occur in association with a tumor without being triggered by direct tumor invasion or compression. They arise from tumor secretions of hormones, peptides or cytokines or from immune cross-reactivity between malignant and healthy tissue. They are categorized into endocrine, neurological, dermatological, rheumatological, and hematological PS. ⋯ The diagnostics are based on the clinical presentation as well as diagnostic methods depending on the underlying pathogenesis. The most important treatment approach involves the best possible treatment of the tumor and a targeted treatment is only sometimes possible. This review focuses on the clinically most frequently encountered PS.
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Pain may have a crucial impact on human quality of life. An increase in knowledge about neurobiological and neuroscientific processes alone can positively influence the subjective perception of pain as well as psychometric variables. There are different forms of preoperative patient education with the aim to explain postoperative pain. Based on current literature, preoperative biomedical education has a low level of evidence. It can increase the preoperative anxiety and stress level of patients, which has a negative impact on the postoperative outcome. In contrast, the neuroscientific understanding considers postoperative pain from the viewpoints of the plasticity of the nervous system and involves sensitizational processes in the central and peripheral nervous systems. ⋯ Preoperative reduction of anxiety and pain-maintaining factors mainly on the psychological and social level may have a positive effect on postoperative subjective pain evaluation, which is reflected in a reduction of anxiety, catastrophizing tendencies, and a lower utilization of postoperative health care services.