Der Schmerz
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Biography Historical Article
[From Descartes to fMRI. Pain theories and pain concepts].
In the seventeenth century the philosopher Rene Descartes was the forerunner by establishing a scientific hypothesis on the origin of pain. Much later, in the nineteenth century, pain hypotheses emerged which explained the pain sensation either on the basis of intense stimulation of any kind of nerve fibers (intensity hypothesis) or on the basis of specific nociceptors (specificity hypothesis). The "gate control theory" established by Melzack and Wall (1964) offered an explanation of modulations of pain sensation by the interaction between nociceptive and non-nociceptive nerve fibers and by descending control in the central nervous system. ⋯ On this basis also new pain therapies have been developed. On the other hand, the methods of functional imaging allow the identification of brain regions related to pain processing at a macroscopic level. This new technology opened up new ways of understanding chronic pain processes and new possibilities for the control of therapeutic effects.
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The history of pain treatment likely started in the cradle of mankind, as the experience of pain from many causes presumably had an aversive dimension comparable in its ranking to elementary sensations and motivations such as hunger, thirst, maintenance of body temperature, and sexuality-all vital for individual and genetic survival. Thus, pain certainly was among the drives to create social behavior and medicine-these functions still are inherent in pain. The period of history from 1500, as considered here, is dominated by the emergence of science. ⋯ During the nineteenth century the most important breakthroughs in pain treatment included general and local anesthesia as well as analgesic drugs from morphine to anti-inflammatory agents. They succeeded in taking the terror out of the agonizing pain of surgery and dramatic courses of diseases. Today's natural extension of the medical success in controlling acute pain may be seen in the period of pain medicine aimed at understanding and preventing chronic pain.
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Review Comparative Study
[Cancer pain management. Basic therapy and treatment of breakthrough pain].
Cancer pain imposes a great burden on patients and results in considerable constraints limiting their quality of life. The basic treatment for chronic pain consists in oral administration of long-acting preparations of various analgesic agents according to a set schedule. ⋯ Rapid-onset and short-acting preparations of highly potent opioids are available for the management of these attacks. To choose the correct analgesic agent, it is essential to take a comprehensive medical history and be aware of the different forms of pain present.
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Editorial Historical Article
[Twenty years of Der Schmerz. Consolidate and expand].
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Historical Article
[From willow bark to the coxibs. Development of antiphlogistic analgesics].
Antiphlogistic analgesics comprise the most widely used class of drugs worldwide. These compounds derive more or less directly from three prototypes which were discovered about 130 years ago in Central Europe: acetylsalicylic acid (aspirin), acetanilide (the forerunner of acetaminophen), and phenazone. All of them are still available. ⋯ They may, on the other hand, cause more unwanted cardiovascular effects than the traditional NSAIDs. Hope for further reduction of unwanted drug effects comes from the recently discovered role of glycinergic spinal pain control. It is hoped that new classes of analgesic compounds may result from these new glycinergic mechanisms.