Schmerz最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-14","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":"[Graded balance in pain therapy : Risk factor-based approaches based on the avoidance-endurance model].","authors":"M I Hasenbring, C Titze","doi":"10.1007/s00482-025-00893-7","DOIUrl":"https://doi.org/10.1007/s00482-025-00893-7","url":null,"abstract":"<p><strong>Background: </strong>Cognitive behavioral therapy (CBT) is one of the most frequently used and effective procedures in pain psychotherapy. Nevertheless, meta-analyses exhibit significant variability in response to treatment. Graded balance interventions (GBI) are among the CBT measures with a specific indication for pain patients who, according to the avoidance-endurance model (AEM), exhibit dysfunctional pain processing with respect to fear-avoidant or suppressive pain responses.</p><p><strong>Aim: </strong>The article presents the individual treatment approach of GBI, which is aimed at patients with subacute or chronic pain and an AEM-based dysfunctional pattern of pain processing. Based on the goal of enabling those affected to flexibly alternate between short-term relaxation and resumption of the respective activity with simultaneous pain relief, the concrete procedure is outlined as a model, illustrated by a case study and the preliminary empirical evidence is presented.</p><p><strong>Methods: </strong>Based on selected empirical literature and clinical case reports, the approach of a modular form of CBT is presented, which, guided by a self-reported screening on pain processing, opens up an individually targeted psychological procedure that can effectively support medical measures.</p><p><strong>Results: </strong>Based on a large number of randomized, controlled clinical trials on the efficacy of CBT in patients with chronic pain in different locations, a first randomized long-term study with individually targeted GBI shows superiority over a standardized procedure in terms of reduction of pain intensity, impairment and emotional distress in patients with subacute radicular pain.</p><p><strong>Conclusion: </strong>The use of GBI opens the way to individualization and thus greater homogenization of the approach, based on contrasting patterns of affective, cognitive and behavioral pain processing. The findings to date provide initial indications of the long-term effectiveness of GBI, although there is still a great need for research with respect to its superiority over generalized CBT and into assumed mechanisms of action.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609268","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":"[Eye movement desensitization and reprocessing (EMDR) in pain therapy : Potentials, mechanisms and clinical applications for chronic pain with traumatic background].","authors":"Stephanie Vock, Jonas Tesarz","doi":"10.1007/s00482-025-00890-w","DOIUrl":"https://doi.org/10.1007/s00482-025-00890-w","url":null,"abstract":"<p><strong>Background: </strong>Eye movement desensitization and reprocessing (EMDR) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is also increasingly being used in pain therapy. The use of EMDR can offer a promising therapeutic approach, particularly for patients with previous traumatic experiences.</p><p><strong>Objective: </strong>This article aims to elucidate the link between chronic pain and traumatic experiences as well as to present the underlying mechanisms, opportunities and limitations of EMDR in this specific context.</p><p><strong>Material: </strong>Based on a selective literature search, the article summarizes the central concepts of EMDR treatment, such as the dual attention focus and bilateral stimulation, and reviews relevant studies on pain reduction.</p><p><strong>Results: </strong>Studies show that EMDR not only reduces psychological stress, which contributes to the chronification of pain but can also reduces the intensity of pain itself. Possible mechanisms of action discussed include the stimulation of the working memory and the modulation of neuronal networks.</p><p><strong>Conclusion: </strong>The integration of EMDR into multimodal pain management programs offers a promising perspective for improving the quality of life in patients with complex pain disorders. Nevertheless, the results emphasize that further research is needed to validate the long-term effectiveness of EMDR and to integrate its use into clinical guidelines; however, the underlying mechanism of action of EMDR is still not conclusively clarified and represents a central goal of future research.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529509","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":"[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 = 721 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 68% of PCS patients exhibited dysfunctional illness behavior, of which 45.5% were dysfunctional endurers (distress endurance response), in 22.3% fear avoidance was present, in 21.6% eustress endurance and in 10.5% an adaptive response. Over the course of rehabilitation the behavioral patterns shifted by 11.3% towards adaptive response and by 10.6% to eustress endurance, which mainly comes from the former distress endurance types (-13.9%). Fear avoidance decreased by approx. 12%. 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% 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":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-20","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":"[Education for medication overuse headache : Results of a systematic literature review].","authors":"Hans-Christoph Diener, M Graf, H Löhr, P Kropp","doi":"10.1007/s00482-025-00891-9","DOIUrl":"https://doi.org/10.1007/s00482-025-00891-9","url":null,"abstract":"<p><strong>Background: </strong>Medication overuse headache (MOH) is often found in patients with chronic migraine as a result of worsening migraine accompanied by increasing amounts of acute medications. MOH is a relevant problem in clinical practice and the current German guideline on MOH recommends educational intervention to guide patients to reduce acute medication use.</p><p><strong>Objectives: </strong>The aim was to investigate published approaches for education in MO (medication overuse) and MOH.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed. Publications were included in which details for education for the prevention and treatment in MO or MOH were described. The educational approaches were analyzed thematically.</p><p><strong>Results: </strong>Twelve publications were included in this analysis. The described educational measures were effective in reducing or preventing MO or MOH. The educational content was heterogeneous, but some common topics were included in most of the educational approaches. These can be categorized in \"education on the OH or MOH concept\", \"risk factors\" and \"treatment options\". In few publications, additional topics related to \"agreement on treatment\" were mentioned.</p><p><strong>Conclusion: </strong>Education is effective in patients with medication overuse or medication overuse headache, but approaches differ. The overview presented here can be used as a basis to develop a structured educational approach for MOH.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326839","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":"[Pain reprocessing therapy - rethinking pain : A new psychotherapeutic approach for the treatment of chronic pain].","authors":"Antje Kallweit, Howard Schubiner","doi":"10.1007/s00482-025-00889-3","DOIUrl":"https://doi.org/10.1007/s00482-025-00889-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain affects millions of people worldwide. Nociplastic pain in particular, characterized by central sensitization and a dysfunctional alarm system, requires innovative therapeutic approaches.</p><p><strong>Objective: </strong>This review introduces pain reprocessing therapy (PRT) as a promising psychotherapeutic approach to specifically disrupt the pain-fear-pain cycle. The theoretical background, practical implementation, and effectiveness, evidence, and feasibility of this new therapeutic method for treating nociplastic conditions are described and discussed.</p><p><strong>Results: </strong>PRT enables patients to develop a new understanding of pain and break the pain-fear-pain cycle. Studies and clinical experience demonstrate that this method can achieve a significant reduction in pain intensity.</p><p><strong>Discussion: </strong>PRT provides an innovative framework for treating chronic pain by combining evidence-based methods and enhancing patient self-efficacy. It has the potential to integrate the biopsychosocial model more effectively into practice and transform the paradigm of pain therapy. Challenges include the diagnostic differentiation of nociplastic pain, the required paradigm shift, and the need for training and time resources. However, studies show promising results for sustainable, patient-centered pain therapy.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302734","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":"[Sequence variants of unknown significance in small fiber neuropathy : Characterization of a heterogeneous patient population].","authors":"Caren Meyer Zu Altenschildesche, Nadine Egenolf, Annette Lischka, Nurcan Üçeyler","doi":"10.1007/s00482-024-00811-3","DOIUrl":"10.1007/s00482-024-00811-3","url":null,"abstract":"<p><strong>Background: </strong>In almost half of patients suffering from small fiber neuropathies (SFN), the etiology remains elusive. For these patients with \"idiopathic SFN\", symptomatic analgesic therapy is the only option. Reports on a potential genetic background of neuropathic pain syndromes are increasing and particularly in SFN patients, several genetic variants were found mainly located in genes encoding voltage-gated sodium channels. Although up to 30% of SFN patients show genetic alterations, most of these remain of \"unknown pathogenic significance\" and little is known about \"genetic SFN\".</p><p><strong>Objectives: </strong>The study aimed to determine clinical characteristics of SFN patients carrying a rare genetic variant of unknown significance in pain-associated genes.</p><p><strong>Materials and methods: </strong>From 2015 to 2020, 66 patients with primarily idiopathic SFN were examined and rare gene variants of unknown significance detected in 13/66 (20%) of these. A detailed medical history with focus on pain was recorded and patients filled in standardized questionnaires to assess physical and emotional burden due to pain.</p><p><strong>Results: </strong>The authors found 13/66 (20%) patients with rare variants of unknown significance located in pain-associated genes who reported pain refractory to analgesic treatment, a higher number of external factors influencing clinical symptoms, and a higher level of physical impairment and emotional stress due to pain compared with patients without such genetic variants.</p><p><strong>Conclusions: </strong>Early genetic assessment is recommended to optimize the management of patients with potentially hereditary SFN. Early access to rehabilitation and mental support as well as a consequent elimination of external triggering factors should be granted.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"204-210"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871233","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":"[Biomarkers in complex regional pain syndrome].","authors":"Michael Alexander Harnik, Gudrun Kindl, Frank Birklein, Heike L Rittner","doi":"10.1007/s00482-024-00856-4","DOIUrl":"10.1007/s00482-024-00856-4","url":null,"abstract":"<p><p>Complex regional pain syndrome (CRPS) is a severe pain disorder with an unclear pathophysiology. Biomarkers offer opportunities to enhance diagnosis, stratification, prognosis, and monitoring. Serum markers such as cytokines and microRNAs show potential but require further research. Local skin markers, particularly pro-inflammatory cytokines, are elevated in the acute stage and correlate with disease activity. Imaging techniques such as skeletal scintigraphy and functional magnetic resonance imaging provide valuable insights into structural and functional changes, despite inconsistent results to date. Psychosocial factors, including pain intensity and psychological comorbidities, are important prognostic indicators. Future research should focus on specific biomarkers to develop mechanism-based treatments. A multidisciplinary approach remains crucial for effective treatment.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"221-231"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010460","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":"[European Medicines Agency checks metamizole: stronger focus on agranulocytosis but also established use in treatment].","authors":"Claudia Bausewein, Frank Petzke","doi":"10.1007/s00482-025-00882-w","DOIUrl":"https://doi.org/10.1007/s00482-025-00882-w","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":"39 3","pages":"165-166"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120686","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 headache questionnaire of the German Migraine and Headache Society (DMKG) : A new tool to improve headache care].","authors":"Ruth Ruscheweyh, Charly Gaul, Thomas Dresler, Tim Patrick Jürgens, David Lewis, Torsten Kraya, Lars Neeb, Victoria Ruschil, Gudrun Goßrau","doi":"10.1007/s00482-025-00870-0","DOIUrl":"10.1007/s00482-025-00870-0","url":null,"abstract":"<p><p>To enable state-of-the-art diagnosis, therapy and monitoring of headache disorders, comprehensive history taking is necessary and can be time-consuming. This is facilitated substantially if the patient gathers the needed information beforehand, using a specialized questionnaire. To this end, experts of the German Migraine and Headache Society (DMKG) have developed the DMKG headache questionnaire. It assesses central information such as headache frequency, characteristics, accompanying symptoms and medication, as well as comorbidities and validated scales for psychological cofactors, disability and quality of life. The complete version for a first visit is complemented by a shorter version for follow-up visits and a specialized cluster headache module. For headache care professionals, the DMKG headache questionnaire is free after registration ( https://www.dmkg.de/dmkg-kopfschmerzfragebogen ). It is available for a printout or as fillable PDF and can be combined with the included PDF headache diary or with the DMKG-App (smartphone headache diary). A digital version is in the planning. The DMKG headache questionnaire is an important step towards quality assurance of headache care in Germany.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"169-176"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415096","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}