Der Schmerz
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Patients' expectations in terms of the benefit of a treatment are key determinants of placebo responses and can affect the development and course of medical conditions as well as the efficacy and tolerability of active medical treatment. The mechanisms mediating these placebo and nocebo effects have been best described in the field of experimental pain and placebo analgesia. However, also in dermatology experimental and clinical studies demonstrate that different skin symptoms such as itch, skin pain and dermatologic diseases can be modulated by patients' expectations. ⋯ Techniques aimed at maximizing positive expectation effects in patients should be implemented in daily clinical routine.
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Preoperative treatment expectations have a significant influence on postoperative pain and treatment outcomes. Positive expectations are an important mechanism of the placebo effect and negative expectations are an important mechanism of the nocebo effect. ⋯ Valid and reliable measurement tools should be applied in clinical trials for a more robust investigation of treatment expectations. Further studies should address possible intervention options so that treatment expectations can also be incorporated into standard clinical care.
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The efficacy of pain therapies can be substantially modulated by treatment expectations, which is reflected by the substantial placebo effects observed in pain (so called placebo analgesia). ⋯ Placebo analgesia is associated with complex neurobiological and -physiological mechanisms. An advanced comprehension of these processes should be applied to optimize existing and future therapeutic approaches in pain therapy.
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Observational Study
[Results of a pilot study on the role of therapy expectation in interdisciplinary multimodal pain therapy for chronic back pain].
Chronic low back pain is a serious persistent illness with profound personal and socioeconomic impact. Interdisciplinary multimodal pain therapy (IMPT) is one of the few evidence-based treatment options for chronic pain. Although it is known that pain perception, as well as its chronification and treatment are affected by patient expectations, only few clinical interventions or guidelines on how to modulate these effects exist. ⋯ Expectancy is an important predictor of treatment outcome in IMPT. In clinical practice, valid methods should therefore be established to reduce negative and promote positive expectations.
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Myalgia describes pain in the skeletal muscles. According to the current German clinical guidelines from 2020 (AWMF register number: 030/051), the initial diagnostic assessment consists of the anamnesis, clinical examination, electrophysiological examination and standard laboratory tests. Additional special examinations, such as molecular genetic investigations, special laboratory tests, medical imaging and muscle biopsy are only needed in certain cases. ⋯ In this context etiologically different diseases are considered, whereby some genetically linked diseases (fascioscapulohumeral dystrophy, FSHD, dystrophia myotonica, McArdle's disease, Pompe's disease, limb girdle muscular dystrophy) are contrasted with diseases with an (auto)immune-related pathogenesis (stiff-person syndrome, Isaacs syndrome). The aspects relevant for the diagnosis are particularly highlighted. The therapeutic aspects of the diseases are not part of this article.