Schmerz最新文献

{"title":"[Diabetes mellitus-a risk factor for pain].","authors":"Annett Eitner","doi":"10.1007/s00482-025-00900-x","DOIUrl":"10.1007/s00482-025-00900-x","url":null,"abstract":"<p><p>A high percentage of the world's population suffers from diabetes mellitus (DM). The disease leads to considerable DM-related pathological consequences and aggravates disease processes and pain as a comorbidity. This has a significant impact on the quality of life of these patients. This article describes DM-induced mechanisms that may contribute to increased pain. Diabetic patients exhibit low-grade systemic inflammation, high levels of blood glucose, and increased formation and accumulation of advanced glycation end products (AGEs). These factors can activate intracellular inflammatory signaling pathways and induce reactive oxygen species (ROS) formation, which can lead to the release of cytokines, oxidative stress, and mitochondrial dysfunction. These processes lead to increased local inflammation and damage to blood vessels and nerve fibers, which are considered to be causes of many diabetic complications. The increased release of pro-inflammatory mediators contributes to peripheral and central sensitization and thus to increased acute and chronic pain in diabetic patients. About 50% of people with DM develop diabetic neuropathy, which can cause numbness, discomfort, or severe pain. In addition, diabetic patients have an increased incidence of musculoskeletal disorders, which can cause additional pain.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"350-358"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comorbidity of chronic pain and fatigue : Common mechanisms, common treatment steps?]","authors":"Monika Hasenbring, C Levenig, C Titze","doi":"10.1007/s00482-025-00898-2","DOIUrl":"10.1007/s00482-025-00898-2","url":null,"abstract":"<p><p>Fatigue and chronic pain show a high level of comorbidity and are both not only frequent symptoms of chronic diseases without known somatic structural causes (e.g. irritable bowel syndrome or nonspecific low back pain) but also as leading symptoms of diseases with a specific etiology (e.g., cancer, rheumatoid arthritis or multiple sclerosis). Fatigue and pain also often co-occur for months or years after overcoming an acute organic illness, such as an acute bacterial or viral infection. In all cases, fatigue and pain can be accompanied by increased anxiety or depression. Moreover, research indicates that psychosocial factors, such as emotional distress, dysfunctional behavioral responses to fatigue or pain or social stigmatizing, can be involved in the perpetuation of the complaints and also independent of the etiology of the underlying disease. Physiological processes, such as autonomic dysregulation, an altered activation of adrenocortical activity as well as altered brain activity are increasingly being discussed as biological mechanisms. These common factors suggest a transdiagnostic approach investigating overlapping features in terms of biopsychosocial mechanisms that may play a role not only in the maintenance of pain but also of fatigue. As a consequence, both the diagnostics and management can be provided in a more individualized and resource-efficient way. The present narrative review gives a preliminary summary of the transdiagnostic mechanisms and possible clinical approaches for fatigue and chronic pain.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"322-328"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Consideration of patient autonomy at the end of life : End of life care between the protection of life and the right to self-determination].","authors":"Sandra Weeger-Elsner, Frank Elsner","doi":"10.1007/s00482-025-00894-6","DOIUrl":"10.1007/s00482-025-00894-6","url":null,"abstract":"<p><p>A person's rights to freedom and self-determination are a valuable asset. At the same time, the state has an obligation to protect life. Tension can arise between these equally important, immutable guarantees in Articles 1 and 2 of the German Basic Law if a person is suffering from severe pain due to an illness and there is no prospect of a cure. If a patient in this situation expresses the wish to die, this represents a major challenge for those providing treatment. Personal conflicts of conscience and uncertainty about the legal situation mean that the patient does not receive the treatment desired for the last phase of life. This article discusses the difficult topic of \"assisted dying\", primarily from a legal perspective. Which (medical) actions are punishable, which are not? What is the legislator doing to ensure legal certainty for everyone involved? How can patients make their own arrangements to ensure that their right to autonomy is respected at the end of life?</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"369-377"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic pain and comorbidity : Just an added burden-or also an opportunity?]","authors":"Monika I Hasenbring, Hans-Georg Schaible","doi":"10.1007/s00482-025-00902-9","DOIUrl":"https://doi.org/10.1007/s00482-025-00902-9","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":"39 5","pages":"307-309"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Opioid prescriptions for insured individuals without cancer in Germany: data from the BARMER].","authors":"Veronika Lappe, Daniel Grandt, Ursula Marschall, Frank Petzke, Winfried Häuser, Ingrid Schubert","doi":"10.1007/s00482-024-00852-8","DOIUrl":"10.1007/s00482-024-00852-8","url":null,"abstract":"<p><strong>Background: </strong>The importance of opioids in the treatment of non-cancer pain is under debate. No current data are available from Germany on the prevalence of opioid treatment for non-cancer pain.</p><p><strong>Aim of the study: </strong>Data on the prevalence of short- and long-term opioid prescriptions for patients without cancer, prescribed agents, co-medication, specialty of prescribing physicians, demographic and clinical characteristics of patients.</p><p><strong>Materials and methods: </strong>Retrospective analysis of billing data of adult BARMER-insured persons without evidence of cancer (N = 6,771,075) in 2021 and for patients initiating opioid therapy in 2019 (n = 142,598).</p><p><strong>Results: </strong>In total, 5.7% of the insured persons without a cancer diagnosis received at least one prescription for an opioid in 2021, while 1.9% received long-term therapy. Tilidine and tramadol were the most frequently prescribed opioids in short- and long-term therapy. Women received opioids more frequently than men. The frequency of prescriptions significantly increased with age. In 2021, 22.5% of insured persons with long-term opioid therapy received a co-medication with pregabalin and/or gabapentin, 37.5% with an antidepressant and 58.1% with metamizole and/or NSAIDs. A total of 59.5% of first prescriptions were issued by general practitioners. In the first year of therapy, an average of 2.1 practices were involved in prescribing analgetics for people on long-term opioid therapy and 13 different chronic diseases were documented.</p><p><strong>Discussion: </strong>Opioid therapy for non-cancer-related pain is predominantly carried out by general practitioners in older and multi-morbid patients. The indication for or against opioid therapy requires shared decision-making with patients and, if necessary, their relatives, as well as a review of possible drug interactions.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"359-368"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Importance of avoidance and endurance in post-COVID syndrome : Can dysfunctional patterns be changed?]","authors":"Alexa Kupferschmitt, Christoph Herrmann, Michael Jöbges, Stefan Kelm, Gerhard Sütfels, Thomas H Loew, Monika Hasenbring, Volker Köllner","doi":"10.1007/s00482-025-00887-5","DOIUrl":"10.1007/s00482-025-00887-5","url":null,"abstract":"<p><strong>Background: </strong>The importance of dysfunctional coping strategies in the chronification of pain is well documented. The avoidance endurance model (AEM) has proven to be well-suited which, according to initial clinical experiences, is also well-suited to depicting dysfunctional illness behavior in post-COVID syndrome (PCS, COVID coronavirus disease). The aim of this study is to demonstrate which patterns occur and how frequently in PCS patients and whether they change in the context of multimodal rehabilitation.</p><p><strong>Method: </strong>As part of the PoCoRe multicenter study, N = 481 PCS rehabilitation patients were examined with respect to illness behavior according to the AEM at the start and end of rehabilitation. Frequency analyses, χ²-tests and Sankey diagrams were used.</p><p><strong>Results: </strong>At the start of rehabilitation around 81.8% of PCS patients exhibited dysfunctional illness behavior, of which 57.7% were dysfunctional endurers (distress endurance response), in 24.1% fear avoidance was present, in 10.0% eustress endurance and in 8.2% an adaptive response. Over the course of rehabilitation the behavioral patterns shifted by 8.8% towards adaptive response and by 12.7% to eustress endurance, which mainly comes from the former distress endurance types (-6.7%). Fear avoidance decreased by approx. 4.8%. Within the individual AEM reaction patterns, dysfunctional patterns can change in favor of functional patterns as well as functional patterns in favor of dysfunctional patterns.</p><p><strong>Conclusion: </strong>The clear predominance of dysfunctional patterns in this highly chronified sample suggests that the avoidance endurance concept is also relevant in the chronification of fatigue in PCS. In contrast to chronic pain patients, however, the endurance patterns clearly predominate here. There was a clear shift towards the functional pattern during rehabilitation, which speaks in favor of modifiability; however, around 10-15% of patients developed in an unfavorable direction, which should be taken into account in treatment planning and investigated further.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"329-338"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Bidirectional relationship between chronic pain and traumatic life events : Mechanisms and therapeutic implications].","authors":"Michelle Hermes, Sebastian Wieland, Jonas Tesarz","doi":"10.1007/s00482-025-00883-9","DOIUrl":"10.1007/s00482-025-00883-9","url":null,"abstract":"<p><p>There is a close bidirectional relationship between chronic pain and psychological trauma disorders, which frequently results in more intense suffering and greater impairment for those affected. This article elucidates the intricate interrelationships between chronic pain, early childhood stress, and traumatic experiences as well as the underlying neurobiological, neuroimmunological and psychosocial mechanisms. Early childhood trauma, such as abuse or neglect, has a significant impact on individuals during particularly vulnerable phases of development, leading to long-lasting changes at various levels. The influence of trauma on pain perception is twofold: it increases the prevalence of chronic pain and intensifies pain and suffering. Therapeutically, interventions that target the hyperactive threat system and strengthen the hypoactive soothing system are essential. The article discusses evidence-based models of pain-trauma interaction and presents therapeutic approaches such as Eye Movement Desensitization Reprocessing (EMDR), Emotional Awareness and Expression Therapy (EAET), and psychodynamic interventions that are promising in the treatment of trauma-associated chronic pain.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"310-321"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Multiple comorbidities with migraine-Is there a common cause?]","authors":"Andreas Straube","doi":"10.1007/s00482-025-00901-w","DOIUrl":"10.1007/s00482-025-00901-w","url":null,"abstract":"<p><p>Migraine is the most frequent neurological disorder and has a prevalence of 10-14% of the population. In addition to the frequency and the fact that it is usually manifested in adolescence, the frequent comorbid illnesses are also the cause of the high burden associated with migraine. Diseases from very different functional areas are associated with the presence of migraine. In general, this increased risk is more pronounced in the presence of migraine with aura and in women. For example, migraine is associated with a higher risk of developing stroke, heart attack, arterial hypertension, depression, anxiety disorder and probably dementia syndromes. The article presents the most important epidemiological studies on a number of these comorbid diseases. It is unclear what the neurobiological basis is for this accumulation of comorbid diseases in migraine. In addition to the purely coincidental cooccurrence in individual cases, other factors can be responsible for the increased risk: a shared genetic background, e.g. in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) or epileptic seizures, or treatment of a primary independent chronic disease (e.g. treatment with phosphodiesterase inhibitors, hormone substitution therapy or beta-interferon therapy). Another cause, which is discussed more broadly here, is inflammatory mechanisms, which are found in both the triggering of migraine and in a variety of comorbid diseases. This applies primarily to all chronic inflammatory diseases such as rheumatoid arthritis but also to depression and cardiovascular diseases. So far, these findings have not had any influence on the treatment of migraine but this may change in the future with a better understanding of the molecular mechanisms (e.g. activation of microglia).</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"339-349"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brückenbauer zwischen Recht und Medizin : Nachruf auf Klaus Kutzer (30.06.1936–27.07.2025) – Vorsitzender Richter am Bundesgerichtshof a. D.","authors":"Roland Wörz","doi":"10.1007/s00482-025-00905-6","DOIUrl":"https://doi.org/10.1007/s00482-025-00905-6","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Migraine patients treated with CGRP(R) antibodies : Are they different from patients treated with nonspecific oral prophylaxis? Analysis from the DMKG headache registry].","authors":"Ruth Ruscheweyh, Gudrun Goßrau, Tim Patrick Jürgens, Victoria Ruschil, Torsten Kraya, Thomas Dresler, Charly Gaul, Jörg Scheidt, Lars Neeb","doi":"10.1007/s00482-025-00899-1","DOIUrl":"https://doi.org/10.1007/s00482-025-00899-1","url":null,"abstract":"<p><strong>Background: </strong>Antibodies against CGRP or its receptor (eptinezumab, erenumab, fremanezumab, galcanezumab, from here on: \"CGRP(R) antibodies\") are modern migraine preventives. German statutory health insurance covers CGRP(R) antibodies only for patients refractory to other preventive therapies. Thus, the effect of this regulation on patient selection was investigated, as well as the effect of a change of insurance coverage for erenumab in October 2022.</p><p><strong>Methods: </strong>In total, 759 patients with CGRP(R) antibody treatment were compared with 961 patients prescribed nonspecific oral migraine preventive medicines (amitriptyline, betablocker, flunarizine, topiramate) from the DMKG Headache Registry.</p><p><strong>Results: </strong>Patients with CGRP(R) antibodies had more prior preventive therapies that were insufficiently effective or tolerated compared to patients prescribed nonspecific oral preventive medicines (p < 0.001). Moreover, they had longer disease duration (p < 0.001), more often suffered from chronic migraine (p = 0.002), had more severe headache days (p = 0.004) and acute medication days (p = 0.04), lower quality of life (p < 0.05), more comorbidities (p = 0.001), and fewer of them were working (p < 0.001). After change of insurance coverage, treatment with erenumab shifted towards less refractory patients (p < 0.001) with shorter disease duration (p < 0.001), who were less severely affected compared to patients with other CGRP(R) antibodies (e.g., headache days p = 0.01; disability p = 0.005).</p><p><strong>Conclusion: </strong>CGRP(R) antibodies are prescribed for to patients affected by exceedingly severe migraine. Insurance coverage has a significant effect on use of medicines for migraine prevention.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}