Der Schmerz
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This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. ⋯ A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications.
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Besides the different forms of odontalgia, myalgias of the masticatory muscles are the most frequent noninfectious complaints in the orofacial region. After summarizing the recommendations set forth by the Interdisciplinary Working Group of Orofacial Pain within the German Chapter of the IASP (German Pain Society), we present the current state of knowledge regarding the etiology, diagnosis, and therapeutic options, based on an extensive literature search. A systematic literature search was carried out in PubMed, the Cochrane Library, and the database of the Deutsche Zahnärztliche Zeitschrift. ⋯ Short- and long-term trials have added more evidence to the fact that different therapeutic measures have similar efficacy. In patients with chronic myalgias of the jaw muscles, involvement of a psychotherapist is crucial. Patient education, oral appliances, physiotherapeutic exercises, and acupuncture are recommended therapeutic measures, while physical therapy, pharmacotherapy, and psychological therapy received a limited recommendation.
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Schwannomas (neurinomas) are among the most frequent peripheral nerve tumors. Nevertheless, these are seldom located in the lower extremities in association with the femoral nerve. ⋯ Although schwannomas of the lower extremities are rare, they should be included in the differential diagnosis. Knowing the typical clinical symptoms, radiological signs, and histopathological findings, diagnosis should be straight forward.
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Peripheral nerve blocks are currently performed relatively blind even in the most complex anatomical structures and physicians mostly rely on palpable anatomical landmarks on the surface. Ultrasound has become an indispensable part of the modern medical world and has long since found its way into almost all medical professions. More and more this trend also reaches interventional pain physicians as it is possible to accurately target structures, to track the needle course during the intervention and to visualize the spread of the local anesthetic. ⋯ A deep understanding of anatomy and its correlate in ultrasound images is one of the most important requirements for the successful use of these interventional techniques. Moreover, the safe performance of the procedure depends on the simultaneous hand-eye coordination. Nevertheless, despite the euphoria ultrasound technology should only be used in pain management with sufficient indications.