Der Schmerz
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In the field of headache disorders, the term "fear of attacks" refers to the fear of a headache attack occurring. Excessive fear of attacks may worsen the course of a migraine and lead to an increase in migraine activity. In the assessment of attack-related fear, a categorical (fear of attacks as a specific phobia) and a dimensional approach (measuring the extent of fear using a questionnaire) are available. ⋯ The treatment of attack-related fear includes behavioral interventions as well as pharmacological therapy. Behavioral interventions have few side effects and are based on the treatment of common anxiety disorders (e.g., agoraphobia). Although the evidence of existing treatments is sparse, attack-related fear should be considered in routine care.
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Narrative Medicine is an interdisciplinary concept that joins literary texts and theory on the one hand with medical education on the other. It suggests that specific skills can be practiced by reflecting about literature and the arts, which represent existential human experiences. These skills are narrative competence, tolerance for ambiguity, changing one's perspective, empathy, and self-care. ⋯ Literary texts in a medical classroom can be a productive resource to practice and critically discuss competences identified in the National Competency-Based Learning Objective Catalogue for Medicine 2.0.
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Macromastia often leads to physical complaints involving pain in the shoulder/neck area. In Germany, there are virtually no reliable data on the effects of breast reduction surgery with regard to neck and spine complaints. Therefore, the authors carried out a retrospective study to investigate the effect of breast-reducing surgery on neck pain and quality of life. ⋯ With this study, the authors were able to show that there are often several reasons why breast reduction surgery is performed in patients with macromastia. A high patient satisfaction rate can be achieved and orthopedic clinical complaints associated with macromastia can be treated with a very high success rate.
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For a long time, biblical views of pain were used to relieve and legitimize suffering. Nowadays, however, pain is seen as an evil to be fought. Despite this difference, it is worth researching the variety of images of pain in the Old Testament in order to include them in current debates. ⋯ Social and political upheavals played a crucial role in the development of Old Testament images of pain. That is why the ultimate cause of pain is only partially attributed to the divine, but more to human violence structures. The texts focus their hope on God as a deliverer from distress because he allows himself to be affected by pain.
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Clinical Trial Controlled Clinical Trial
[Less surgery and lower cost due to back pain in a care program with an interdisciplinary second opinion procedure : A controlled non-randomized intervention study based on claims data].
There is no evidence of effectiveness for interdisciplinary second opinion procedures (ISOP) for recommended back surgery (BS). Since 2015, AOK Nordost has been offering the care program RückenSPEZIAL comprising a preliminary examination, ISOP, and optional interdisciplinary multimodal pain therapy (IMPT). The objective of this study is to determine the effectiveness of RückenSPEZIAL to reduce BS and back pain-related costs (BPRC) compared to patients who likewise received a recommendation for back surgery but not RückenSPEZIAL. ⋯ The differences in BS were significant (p < 0.05) and in favor of RückenSPEZIAL. For the specific population it can be expected that mainly savings on BS can cover the intervention costs of RückenSPEZIAL (approximately significant, small case number). Bias due to self-selection needs to be assumed.