Der Schmerz
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The intensity of pain cannot be measured directly but can only be described subjectively. This obviously complicates the assessment especially in the younger age group. Pain evaluation and documentation are essential for good results in pain therapy. ⋯ In neonates and children up to 4 years of age, standardized scales have been developed for observation of their activities. Children in the age group 4-6 years old are able to communicate about pain. At this age self-report scales can be used to assess pain sensations."Quality Improvement in Postoperative Pain Management in Infants" (QUIPSInfant) represents a new tool for pediatric outcome evaluation, consisting of standardized data acquisition of outcome and process quality indicators.
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Previous studies suggested that areas of the neural"pain matrix" are activated by the processing of pain-related environmental cues such as pain-related pictures or descriptors of pain. However, it is still sketchy whether these activations are specific to the pain-relevant content of the stimuli or simply reflect a general effect of negative emotional valence or increased arousal. The present study addressed this question by investigating the neural mechanisms underlying the processing of pain-related, negative (non-pain-related), positive and neutral words. ⋯ When attention was focused on a distracting task (distraction task), we found a decrease in activation within the dorsal anterior cingulum (dACC) and a relative increase in activation within the subgenual anterior cingulum (sACC) when processing pain-related words compared to other words. These results indicate that the differences in processing pain-related words compared to non-pain-related words are specific to the content of the words and cannot simply be explained by emotional valence or arousal. Additionally, we showed that the specific activations to pain-related words are substantially modulated by the attention demands of the task.
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This study features an analysis of the analgesic therapy of patients with back pain focusing on opioid administration. Using claims data of a German statutory health insurance fund the analysis focuses on prescription patterns, the association between opioids and antiemetics as well as between opioid therapy and work disability. Based on typical diagnosis patterns three types of back pain could be identified: (other) specific back pain (46.0%), pain due to spinal disc diseases (23.5%) and non-specific back pain. ⋯ The chance of continuous opioid therapy was higher in pain patients with spinal disc diseases and patients with (other) specific back pain (OR 1.62 and 1.76, respectively; 95% CI 1.56-1.69 and 1.69-1.83, respectively). Continuous opioid therapy appears to increase the probability of a lower number of days off work due to disability (incidence rate ratio [IRR] 0.76; 95% CI 0.70-0.84). Adequate prospective studies should test if the associations found can be confirmed.
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The variables pain intensity (SI), disability (DS) and quality of life (QoL) belong to a set of primary patient-based outcomes in chronic low back pain (CLBP). The avoidance-endurance model (AEM) assumes three maladaptive and one adaptive pain response pattern. The purpose of this study was to study the level and course of the outcomes with regard to the four AEM patterns. ⋯ The results show differences in the level and process of SI, DS and QoL between the subgroups. An AEM-based classification of subgroups is also reasonable for CLPB patients.