Der Schmerz
-
The study was performed to reveal the effect of an individualized personal outpatient therapy program, based on a multidisciplinary assessment, on pain and health-related quality of life in patients with chronic pain. ⋯ An individualized personal outpatient therapy program has only marginal effects on pain and health-related quality of life in patients with chronic pain.
-
Functional brain imaging techniques allow to noninvasively visualize neuronal activity and associated metabolic consequences. In combination with elegant experimental paradigms in both healthy volunteers and, increasingly, in patients, functional brain imaging has led to a vast accumulation of knowledge concerning the CNS mechanisms involved in pain perception and pain modulation in humans. The so-called "pain matrix" represents a dynamic network of cortical and subcortical brain regions regularly activated by acute pain. ⋯ This system includes cingulo-frontal brain areas together with specific brainstem nuclei that can exert control over nociceptive input at the level of the dorsal horn of the spinal cord. Recent studies support the view that a dysfunctional interaction between the ascending and descending pain system may contribute to the development or maintenance of chronic pain states. Here we provide an overview of the principles, applications, key findings and recent advances of functional imaging in pain research.
-
The European Association for Palliative Care (EAPC) considers sedation to be an important and necessary therapy option in the care of selected palliative care patients with otherwise refractory distress. Prudent application of this approach requires due caution and good clinical practice. ⋯ Procedural guidelines are helpful to educate medical providers, set standards for best practice, promote optimal care and convey the important message to staff, patients and families that palliative sedation is an accepted, ethical practice when used in appropriate situations. EAPC aims to facilitate the development of such guidelines by presenting a 10-point framework that is based on the pre-existing guidelines and literature and extensive peer review.
-
Fibromyalgia poses a challenge for therapy. Mainly comorbid depression has a negative impact on symptoms and impairment in patients with fibromyalgia. This paper gives a systematic overview of how depressiveness affects physical and psychological impairment, coping with disease and rehabilitation outcome among patients with fibromyalgia. The databases PubMed, Embase and PsychINFO were searched for studies published up to April 2010. ⋯ Fibromyalgia patients with depressive symptoms show more sleep disturbances, sexual dysfunction, loss of physical function level and lower quality of life. Patients with fibromyalgia and comorbid depression showed poorer outcomes of multimodal rehabilitation than patients with fibromyalgia without depression. Therefore the assessment of depression should be included in the routine diagnostics of fibromyalgia. Furthermore, patients with fibromyalgia and comorbid depression should be motivated to seek therapy and get better support in coping with depression.