Schmerz最新文献

{"title":"[Opportunities and risks of advance directives : An appraisal of the practice in Germany after legal regulation in 2009].","authors":"Christoph G Dietrich, Konrad Schoppmeyer","doi":"10.1007/s00482-023-00771-0","DOIUrl":"10.1007/s00482-023-00771-0","url":null,"abstract":"<p><strong>Background: </strong>Living wills/advance directives (AD) are an important tool for specifying patient wishes regarding medical care in the case of future inability to consent. Since 2009, German legislation defines framework conditions for the creation and validity of such directives in § 1901a BGB.</p><p><strong>Methods: </strong>An extensive literature search in an international and a German-language database was conducted to identify, analyze, and evaluate scientific articles on opportunities, risks, and problems in the creation and implementation of living wills.</p><p><strong>Results: </strong>Between 10 and 40% of patients have an AD. Among the stipulations in the AD, the demand for sufficient pain therapy is very important. However, numerous problems in the preparation and implementation of ADs reduce their value in everyday clinical practice. In particular, unclear conditions of validity, unspecific instructions for action, and lack of availability of the directives prevent practitioners from determining the patient's will. Other fundamental problems include frequent patient ambivalence and clinical ethical dissent. In addition, the framework condition of unlimited coverage set by the law carries the risk that changes of opinion in the course of life or disease are not taken into account.</p><p><strong>Conclusion: </strong>Preparing an AD requires a high level of information, consultation, and time, as well as regular review or adjustment of its content. These factors are often not considered, thus complicating implementation and reducing the value of living wills. Possible solutions to these problems or alternative concepts for different patient settings are discussed in this review.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"133-140"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139074974","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":"[Development and validation of a questionnaire to assess physiotherapists' postural-structural-biomechanical-oriented beliefs about pain].","authors":"Ahura Bassimtabar, Martin Alfuth","doi":"10.1007/s00482-023-00757-y","DOIUrl":"10.1007/s00482-023-00757-y","url":null,"abstract":"<p><strong>Background: </strong>Therapists frequently use the postural-structural-biomechanical (PSB) model in clinical practice to explain the symptom of pain using biomechanical deficits. Adequate knowledge about pain encompasses not only the neurophysiology of pain but also knowledge that existing PSB-oriented explanations of the development and enhancement of pain are outdated. There is no assessment to evaluate physiotherapists' PSB-oriented beliefs about pain.</p><p><strong>Aim: </strong>The aim of the present study was to develop a questionnaire to assess physiotherapists' PSB-oriented beliefs about pain and to evaluate its reliability (internal consistency), validity, and agreement.</p><p><strong>Methods: </strong>The Essential Knowledge of Pain Questionnaire (EKPQ) was constructed on the basis of a literature search and discussions between experts. In a pilot study, 32 pupils of a physiotherapy school were then asked to complete the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the EKPQ using the SoSci Survey in order to assess their knowledge and beliefs about pain.</p><p><strong>Results: </strong>The internal consistency of the EKPQ was acceptable with a Cronbach's α = 0.784. There was a strong positive significant correlation between the questionnaires (r = 0.518; p = 0.002). The Bland-Altman analysis revealed a mean difference of 28.9% (± standard deviation of the difference 15.3%) with an upper limit of 95% agreement of 58.8% and a lower limit of 95% agreement of -1.0% between the questionnaires. Participants achieved a mean score of 60.7% in the rNPQ‑D and a mean score of 31.8% in the EKPQ.</p><p><strong>Conclusion: </strong>The newly developed EKPQ questionnaire seems to be a reliable and valid assessment to determine physiotherapists' PSB-oriented beliefs about pain. The results also confirm that a high level of knowledge about the neurophysiology of pain does not exclude a PSB orientation. Whether the EKPQ can be used alongside the rNPQ as an additional assessment to evaluate beliefs about pain should be investigated in the future with suitable study designs, e.g. Delphi study.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"117-125"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238331","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":"[Drug safety and mandatory reporting].","authors":"Christian Behles, Robert Hoffmann, Dennis Lex","doi":"10.1007/s00482-024-00857-3","DOIUrl":"10.1007/s00482-024-00857-3","url":null,"abstract":"<p><p>The spontaneous reporting system for cases of suspected side effects is a central instrument for detecting possible side effects after a pharmaceutical preparation has received marketing authorization. It provides important information (signals) on the occurrence of rare, previously unknown side effects, on increases in the frequency of known side effects that may also be due to quality defects, or on changes in the type or severity of known side effects. In recent decades, this system has made a significant contribution to the identification of drug-related risks that only arise upon widespread use following approval and to the introduction of appropriate measures to minimize risk.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"147-159"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024681","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":"[\"Children\" are not just \"children\"! : The complexity of pediatric pain treatment].","authors":"Boris Zernikow","doi":"10.1007/s00482-025-00873-x","DOIUrl":"https://doi.org/10.1007/s00482-025-00873-x","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":"39 2","pages":"87-88"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711164","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 and its limits : A phenomenological consideration of chronic pain].","authors":"Judith N Wagner","doi":"10.1007/s00482-023-00776-9","DOIUrl":"10.1007/s00482-023-00776-9","url":null,"abstract":"<p><p>Chronic pain poses a significant global socio-medical challenge causing significant costs. It is only since the mid-20th century that pain syndromes have been considered diseases in their own right. According to the definition of the International Association for the Study of Pain, pain is a complex, context-dependent-and hence modifiable-phenomenon. The philosophical view on pain is no less multi-facetted and allows for a wide range of viewpoints. This analysis aims at a characterisation of pain including a-mainly phenomenological and enactivist-philosophical perspective. The discourse will be guided by the concept of the limit(s) of the lived body: what is the relationship between pain and the perception of the lived body's boundaries? Does a reciprocal influence exist? And may the perception be modified in order to reduce the patient's suffering? These musings will also clarify that neurosciences and philosophy are not competing sciences, but rather inform each other.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"108-116"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404245","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":"[Retropharyngeal calcific tendinitis-An underestimated cause of acute neck pain].","authors":"Joachim Wolf, Pascal Niggemann, Neysan Schaefer, Nadine Tollens, Michael Rittmann, Michael Martins Dos Santos, Britta Tews","doi":"10.1007/s00482-023-00735-4","DOIUrl":"10.1007/s00482-023-00735-4","url":null,"abstract":"<p><strong>Background: </strong>Retropharyngeal calcific tendinitis is an aseptic inflammation of the longus cervicis muscle. This rare acute pain disorder of the neck region is a prognostically benign condition compared to neurological or otorhinolaryngological differential diagnoses.</p><p><strong>Objective: </strong>To capture the clinical appearance, diagnostics, treatment and course of this rare disease.</p><p><strong>Material and methods: </strong>In this retrospective monocentric observational study, demographic, clinical, paraclinical as well as treatment and follow-up data of all inpatients with a diagnosis of retropharyngeal calcific tendinitis admitted to the Diako Hospital Mannheim in the years 2018 to 2021 were analyzed.</p><p><strong>Results: </strong>This study included four female and one male patient with an age between 36 years and 77 years. Severe neck pain with restriction of cervical spine rotation was the leading clinical appearance, in four out of five patients there was a painful swallowing disorder. Inflammatory markers were elevated in four patients. Characteristic MRI or CT imaging alterations of the cervical spine confirmed the diagnosis. The symptoms resolved within 4-14 days after treatment with nonsteroidal anti-inflammatory drugs (NSAID) and four patients additionally received glucocorticoids. No recurrences were observed during the follow-up period of 5-30 months.</p><p><strong>Conclusion: </strong>The good prognosis of this rare disease is reflected by the rapid remission of symptoms under NSAIDs and glucocorticoids and by the absence of recurrences during follow-up. CT or MRI imaging is required to rule out differential diagnoses, and to confirm the characteristic imaging alterations of retropharyngeal calcific tendinitis. Additionally, cerebrospinal fluid puncture and otorhinolaryngological assessment may be necessary in some cases.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"126-132"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9749007","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":"[Translating evidence: pain treatment in newborns, infants, and toddlers during needle-related procedures : German version].","authors":"Denise Harrison, Mariana Bueno","doi":"10.1007/s00482-024-00797-y","DOIUrl":"10.1007/s00482-024-00797-y","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2 years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented.</p><p><strong>Objectives: </strong>To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice.</p><p><strong>Methods: </strong>This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented.</p><p><strong>Results: </strong>Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needlerelated procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist.</p><p><strong>Conclusion: </strong>There is evidence of effective pain management strategies for newborns, infants, and toddlers, and a great deal of effort is being made to translate knowledge into action.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"89-98"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140022501","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":"[Use of strongly acting sustained-release opioids in pediatrics : Pitfalls and solutions for morphine and hydromorphone].","authors":"Franziska Zimbelmann, Sarah Flaute, Melanie Deipenbrock, Elvira Ahlke, Georg Hempel, Margit Baumann-Köhler","doi":"10.1007/s00482-023-00775-w","DOIUrl":"10.1007/s00482-023-00775-w","url":null,"abstract":"<p><strong>Background: </strong>In pediatrics, adequate treatment with potent opioids requires the administration of sustained-release preparations for many patients; however, the dosing and administration of sustained-release morphine and hydromorphone preparations via gastrointestinal tubes confronts providers with a major hurdle, especially as the company Mundipharma GmbH has discontinued the production and distribution of the preparation MST retard granules in 2019, which has been proven for these purposes in pediatrics. The aim of this study was to establish a production technique for available sustained-release opioid preparations, which are particularly suitable for use in the low-dose range required in pediatrics and which can also be administered via gastrointestinal tubes.</p><p><strong>Method: </strong>Low-dose preparations were produced by opening of morphine and hydromorphone capsules and weighing of the sustained-release pellets. To evaluate the partition, an analysis of the drug content via high performance liquid chromatography (HPLC) was conducted. Moreover, the administration via gastrointestinal tubes (charrière, Ch 8-Ch 10) was examined by an ex vivo experiment.</p><p><strong>Results: </strong>The examination showed a practicable method to produce low dosages of sustained-release morphine and hydromorphone. The preparations are in accordance with the test for content uniformity of the European Pharmacopoeia (Ph. Eur.). Furthermore, the pellets were administered to gastrointestinal tubes Ch 8 (morphine) and Ch 10 (hydromorphone) by a syringe application technique and passed the tubes completely.</p><p><strong>Conclusion: </strong>The production technique can be considered as safe and enables the off-label oral application or application via gastrointestinal tubes of sustained-release opioids in pediatrics.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"99-107"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139088176","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":"[Opioid withdrawal following refilling of an implantable drug delivery system for intrathecal infusion].","authors":"Marco Reining, Michael Kretzschmar","doi":"10.1007/s00482-023-00779-6","DOIUrl":"10.1007/s00482-023-00779-6","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"141-143"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139088175","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 management in geriatric patients-methods paper for the S3 guideline \"GeriPAIN\"].","authors":"Melina Hendlmeier, Thomas Fischer, Corinna Drebenstedt, Stephan Fuchs, Heike Norda, Erika Sirsch","doi":"10.1007/s00482-025-00875-9","DOIUrl":"https://doi.org/10.1007/s00482-025-00875-9","url":null,"abstract":"<p><p>Geriatric patients are characterized by an advanced age and typical geriatric multimorbidity. The prevalence of pain increases with age. In geriatric patients in particular, pain is one of the most frequently occurring characteristic complexes. In Germany, a trend has been observed that the prevalence and intensity of pain in older people has continued to increase in recent years. Pain management in this particularly vulnerable group poses major challenges for the patients themselves, their relatives and healthcare professionals. For this reason, the expiring S3 guideline on \"Pain assessment in older people in full inpatient care for the elderly\" will be taken up, updated and expanded to include pain therapy and extended to outpatient and acute inpatient care.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721293","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}