Der Schmerz
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Emotional and physical abuse and neglect in childhood and adolescence [childhood maltreatments (CMs)] are considered to play a role in the etiology of fibromyalgia syndrome (FMS). Whether the association between FMS and CMs can be explained by mediators has not been studied. ⋯ Prospective population-based studies controlling for depression are necessary to determine the role of CMs in the etiology of FMS.
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Medical treatment for certain chronic headache syndromes such as hemicrania continua (HC), chronic migraine (CM) or chronic cluster headache (CCH) is challenging and in many cases does not lead to sufficient pain relief or is limited by severe side effects. In the last few years neuromodulatory treatments such as subcutaneous stimulation of the greater occipital nerve or deep brain stimulation (DBS) in the hypothalamus have evolved. This report focuses on current knowledge and the results of peripheral subcutaneous nerve stimulation (SPNS) in the literature of the described headache syndromes and presents our own long-term results in ten patients. ⋯ In summary, peripheral nerve stimulation of the greater occipital nerve is less invasive but also less effective in comparison to hypothalamic stimulation. However, the severity and frequency of pain attacks is significantly reduced. For other intractable headache syndromes SPNS of the greater occipital nerve offers a reasonable addition to medical treatment.
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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.
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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.