Der Schmerz
-
The genesis of chronic pain is predominantly explained by a multidimensional pain model approach that is based on the dysfunctional influence of biological, psychological and social variables as key risk factors inducing aberrant long-term changes. Biological facets comprise adaptation processes on the neuronal, musculoskeletal and (psycho) biological level that can be influenced by physical training or psychosocial factors, such as stress. ⋯ The aim of this review article is to discuss hypotheses for the genesis of chronic pain and possible treatment strategies. Selected research results about maladaptive processes in chronic pain due to psychological stress and physical activity are presented in order to inspire discussions about the ideal dose-response relationship of physical activity and the combination of different therapeutic concepts.
-
Many factors seem to be causal for non-specific low back pain and are sometimes controversially discussed. Some years ago the concept of subjective body image attracted attention but due to the inconsistent use of terms and concepts it is difficult to classify publications in the literature. Studies confirmed a difference between the body images of patients with low back pain and healthy controls so that an inclusion of body image concepts could be relevant for causation and therapy. ⋯ Further studies are necessary which include body image concepts as a possible psychosocial risk factor, in particular studies on the mechanism of body image procedures.
-
Research on placebo responses has made major progress in recent years. Placebo responses are psychobiological events, which are created by the entire therapeutic context. They can appear at any time, not only in experimental and clinical settings. ⋯ The current state of research suggests that placebo responses could be used in clinical contexts and should not be viewed as being in competition with medications but as an additive increase in efficacy of a pharmacological substance through specifically induced placebo responses. This targeted use is also possible within ethical guidelines. Important prerequisites are that the research results can be transferred from healthy participants to patients and that the placebo responses are reproducible.
-
In addition to being a risk factor for the course of chronic pain, the personality characteristics of the individual attachment style are also predictors for the success of medical and psychosocial interventions and aspects of the physician-patient relationship. Insecurely attached patients seem to be less able to sustain the positive effects of pain therapy. These results are especially relevant as insecure attachment patterns are overrepresented among chronic pain patients. As a result the attachment style can be seen as a psychosocial vulnerability factor for the chronification of acute pain.
-
Review
[Physical activity and musculoskeletal pain : A focus review within the MiSpEx research group].
Chronic pain diseases are often accompanied by a subjectively perceived impairment in physical activity. Moreover, to date it has not been possible to formulate general recommendations on a therapeutic quantity of physical activity and how activities of daily life and movement exercises should be designed for specific patient populations. ⋯ In particular, a temporary exacerbation of symptoms after an exercise intervention could pose a serious problem concerning patient adherence to treatment. Studies investigating the influence of psychosocial risk factors on pain and disability indicate the need for more individualized pain management techniques.