Fallbericht über eine an COVID-19 erkrankte Patientin mit bestehendem Schmerzsyndrom.

CASE REPORT: Patient with COVID-19 and pre-existing pain syndrome Abstract. Background: This paper focuses on the case study of a patient in the UK who showed - as far as we know today - all typical symptoms of an infection with SARS-CoV-2 but without dyspnoea. The diagnose was made on the basis of the symptoms, which were described by the patient, and confirmed by an antibody test in August 2020. Aim: Due to the public interest in knowing more about the cluster of symptoms and their implications for nursing, the patient and the author of this paper decided to present this case study to the professional audience. Methods: For the anamnesis, the patient's COVID-19 diary and an essay by her about her experiences with the National Health Service (NHS) were analysed and completed by information collected during a structured interview. Results: It became apparent that the nursing diagnoses "Acute pain" and "Chronic pain" stand at the forefront. These nursing diagnoses have not been discussed in the context of COVID-19 yet. Conclusions: This leads to the conclusion that nursing diagnoses, which are orientated towards an alleged lung disease, might not be complete when it comes to the complex disease process of COVID-19. Furthermore, this case example highlights the difficulties faced by the UK health system.

[Pain management in nursing care in outpatient older adults in need of care]. / Pflegerisches Schmerzmanagement bei ambulant versorgten Pflegebedürftigen.

Pain management in nursing care in outpatient older adults in need of care Abstract. Background: International data report a prevalence rate for chronic pain of up to 50 % in community dwelling older adults (> 65 years). A national study reported a prevalence rate of 68,5 % among outpatient adults (≥ 18 years). Nursing care has an important meaning in pain management. However, previous research on the quality of pain management in nursing care is insufficient. Aim: The aim of this study is to evaluate the appropriateness of pain management in nursing care in our target group. Method: The cross-sectional study is based on data from ACHE. The study comprises 219 patients. Information on subjective pain experience and pain management were obtained by face-to-face interviews and nursing documentation. Results: Our findings indicate considerable deficits in terms of pain management in nursing care. Results show a lack of systematic pain assessment as well as missing documentation of therapeutic aims and pain management in nursing care. Conclusions: The identified deficits might be the result of current framework conditions that separate nursing pain treatment in Volume V and Volume XI of the German Social Security Code services. Appropriateness in pain management in nursing care can only be ensured if framework conditions are optimized.

Wann und wie berücksichtigen Intensivpflegende Schmerz im Behandlungsprozess von Patientinnen und Patienten auf der Intensivstation? - Eine qualitative Studie.

When and how do intensive care nurses consider pain in the treatment process of ICU patients? A qualitative study Abstract. Background: Pain management is important in the therapeutic spectrum of the intensive care unit. However, guideline recommendations are not consistently implemented. Strategies in clinical reasoning and decision-making regarding pain are hardly described. AIM: Guided by the question "When and how do intensive care nurses consider pain in the treatment process of patients with impaired consciousness and cognition?", we wanted to explore their patterns of thought and decision-making in the context of pain management. METHODS: As part of a Mixed Methods research program on pain assessment in nonverbal intensive care patients we performed a secondary analysis of data from the qualitative substudy using qualitative content analysis according to Mayring. RESULTS: Pain plays an important but subordinate role in the treatment process. After vital functions have been initially stabilized, intensive care nurses assess patients' consciousness and cognition in order to receive further information directly from them. Intensive care nurses differentiate between pain, anxiety, stress and discomfort. Their decisions are based on experience and intuition. CONCLUSIONS: Education promotes intensive care nurses' knowledge and awareness in pain management. Observational pain assessment instruments provide valid information. They support an analytical approach and thus the development of competence in clinical reasoning and decision-making.

[Pain therapy in Germany - what is the difference between initial outpatient and inpatient treatment? : Assessment based on the KEDOQ pain dataset]. / Schmerztherapeutische Versorgung in Deutschland ­ was unterscheidet ambulante und stationäre Patienten zu Behandlungsbeginn? : Eine Auswertung auf Basis des KEDOQ-Schmerz-Datensatzes.

A comparison of chronic pain patients in outpatient and inpatient treatment settings regarding pain-related and psychological characteristics, has not yet been systematically analyzed. The core documentation and quality assurance in pain therapy (KEDOQ-Schmerz) is a quality assurance system for documentation and quality management of pain therapy in different treatment settings. The system was initiated by the German Pain Society. We used KEDOQ-Schmerz data to describe differences between patients being treated in outpatient and inpatient settings with respect to social, pain-related and psychological factors. In total, the set of KEDOQ-Schmerz data analyzed included information from 4705 patients (from 13 clinics) collected between January 2012 and April 2016. Patients received either outpatient (n = 2682) or inpatient (n = 2023) treatment. The data analyzed comprised sociodemographic, pain-related and psychological data collected through the German Pain Questionnaire (DSF) at the beginning of treatment as well as information about pain chronification and pain localization provided by practitioners. The statistical analysis was carried out by descriptive and comparative data analysis using univariate and multivariate statistical methods. Patients with inpatient treatment were significantly older, more often female and more often had multiple pain localizations. They described stronger pain intensity and more frequently had a higher Mainz Pain Staging System (MPSS) score of pain chronification. They described a significantly poorer physical and mental health-related quality of life in the short form (SF-12) health survey, had significantly higher depression, anxiety and stress values (DASS) and a poorer habitual well-being in the Marburg questionnaire on habitual well-being (MFHW). Significant group differences had only small effect sizes. Even though most predictors for the inpatient treatment setting in multivariate analysis were significant, in total they explained less than 5% of the variance. The results indicate that pain therapy in specialized pain settings more and more has to manage patients with higher pain chronification, higher pain-related stress and previous therapy experience. The differences in patient characteristics between treatment settings are mostly clinically unimportant. Differences in clinical features do not declare the allocation to one treatment setting or the other.

Attitudes of Swiss veterinarians towards pain and analgesia in dogs and cats.

A survey was performed to evaluate the use of perioperative analgesia in dogs and cats by veterinary practitioners. Questions were grouped in seven sections recording personal data, education in veterinary analgesia, general ideology regarding treatment of perioperative pain, personal experience, assessment, and use of main analgesics to treat perioperative pain. A total of 258 received forms were analyzed. Based on 5 questions, 88 % showed excellent motivation to use perioperative pain therapy. The main reason declared for the use of analgesics was to relieve the patient from pain (64.1 %). Most veterinarians reported to routinely administer analgesics before (71 - 96 %) or after (2 - 23 %) surgery. The most used analgesics were non-steroidal anti-inflammatory drugs (carprofen, meloxicam) and opioids (butorphanol, buprenorphine). Animals were routinely evaluated for pain after recovery. Only 43.8 % of veterinarians declared to use loco-regional anaesthesia. Swiss veterinarians appear to recognize well the need for perioperative pain treatment. However, weakness was shown in evaluating pain severity, distinguishing between opioid classes, and using loco-regional anaesthesia.

En 2010 un questionnaire sur le thème de l'analgésie péri-opératoire chez le chien et le chat, divisé en sept chapitres, a été envoyé à 1000 vétérinaires suisses. Outre les données personnelles et les informations relatives aux formations suivies en matière de traitement de la douleur, on s'est intéressé aux conceptions personnelles quant à la lutte contre la douleur, aux expériences faites dans cette lutte ainsi qu'à l'utilisation des principaux analgésiques. Au total, ce sont 258 questionnaires qui ont été analysés. Chez 88 % des personnes, la motivation à utiliser des analgésiques lors d'opérations était élevée. La raison principale de cette utilisation était la réduction des douleurs (64.1 %). La plupart des vétérinaires déclaraient administrer des antalgiques avant (71 ­ 96 %) ou après (2 ­ 23 %) l'intervention. Il s'agissait principalement d'anti-inflammatoires non stéroïdiens (Carprofène, Meloxicam) et d'opioïdes (Butorphanol, Buprénorphine). Après guérison, 97 % des animaux étaient contrôlés de façon routinière par les vétérinaires quant aux douleurs. 43.8 % des vétérinaires utilisaient des techniques d'anesthésie locorégionales. En Suisse, la profession vétérinaire a reconnu la nécessité d'une antalgie péri-opératoire. Toutefois les différences d'intensité douloureuse prévisibles selon les opérations de même que les différences entre les diverses classes d'opioïdes sont estimées différemment de ce qu'on prévoyait. Les techniques d'anesthésie locorégionales sont relativement peu utilisées.

Low Inter-Rater Reliability and Reproducibility of Neck Reflex/"Adler-Langer" Points in Neural Therapy Diagnostics but Increased Pressure Pain Threshold after Therapy: Results of a Randomized Controlled Observer-Blind Trial.

BACKGROUND: Neck reflex points or Adler-Langer points are commonly used in neural therapy to detect so-called interference fields. Chronic irritations or inflammations in the sinuses, teeth, tonsils, or ears are supposed to induce tension and tenderness of the soft tissues and short muscles in the upper cervical spine. The individual treatment strategy is based on the results of diagnostic Adler-Langer point palpation. This study investigated the inter- and intra-rater reliability and explored treatment effects. METHODS: We performed a randomized controlled trial with 104 inpatients (80.8% female, 51.8 ± 12.74 years) of a German department for internal and integrative medicine. Patients were randomized to individual neural therapy according to the pathological findings (n = 48) or no treatment (n = 56). In each patient, three experienced raters (20-45 years of experience in neural therapy) and two novice raters (medical students) rated Adler-Langer points rigidity on a standardized rating scale ("strong," "weak," "none"). The patients independently evaluated the tenderness on palpation of the eight points using the same scale. Pressure pain thresholds were assessed at the eight Adler-Langer points. All patients were retested after 30 min. The five raters were blinded to treatment allocation and assessments of the other raters. Video recordings were obtained to assess the consistency of the areas tested by the different raters. RESULTS: Agreement between patients and raters (Cohen's kappa = 0.161-0.400) and inter-rater reliability were low (Fleiss kappa = 0.132-0.150). Moreover, the individual agreement (pre-post comparisons in untreated patients) was similarly low even in experienced raters (Cohen's kappa = 0.099-0.173). Video documentation suggests that raters do not place their fingers in the correct segments (percentage of correct position: 42.0-60.6%). Pressure pain thresholds at five of the eight Adler-Langer points showed significant changes after treatment compared to none in the control group. CONCLUSION: Under this artificial experimental setting, this method of Adler-Langer point palpation has not proven to be a reliable diagnostic tool. But it could be shown that, as claimed by the method, the tenderness in five of eight Adler-Langer points decreased after neural therapy.

[Castration in the bull calf and ram lamb]. / Die Kastration beim männlichen Kalb und Lamm.

This paper aims to provide an overview of the accepted techniques of pain relief and castration and guidelines of how to best perform these painful interventions in an animal-friendly way under Swiss conditions. Calves should be castrated at the age of 14 days or less, at least 10 minutes after local anesthesia with lidocaine, applying a single rubber ring. Concurrently, a NSAID should be administered intravenously (ketoprofen, 3 mg/kg of bodyweight) and Tetanus-serum subcutaneously (off label use). If possible, ketoprofen(4.5 mg/kg BW) should be orally administered for 3 - 5 days postoperatively. At 10 days after applying the rubber ring, the dried-off scrotum including the rubber ring should be removed with a clean knife or a scalpel. Local anesthesia is not necessary for this procedure. Ram lambs should be castrated at the age of 14 days or less, at least 10 minutes after local anesthesia with lidocaine, applying a rubber ring. The toxic dose of 4 mg lidocaine/kg BW (corresponds to 1 ml lidocaine 2 % per lamb of 5 kg BW) should not be exceeded. Concurrently, a NSAID (off label use) and Tetanus-serum should be administered systemically. Immunization against GnRH represents an animal-friendly and economically feasible alternative to rubber ring castration. With two immunizations at an interval of 3 - 4 weeks testicular development can be inhibited for at least 3 months and the onset of puberty clearly delayed. However, a specific vaccine for use in ruminants is currently registered neither in Switzerland nor in Europe.

Le présent travail donne un aperçu des méthodes praticables pour l'anesthésie et la castration ainsi que des recommandations pour une réalisation de cette intervention dans le respect du bien-être animal dans les conditions suisses. Les veaux devraient être castrés dans les 14 premiers jours de vie au moyen d'un élastique posé au plus tôt 10 minutes après la réalisation de l'anesthésie locale avec de la lidocaïne. Il convient d'administrer simultanément un AINS (kétoprofène, 3 mg/kg PC) en i/v lente ainsi qu'un sérum antitétanique (reconversion). Dans la mesure du possible, il convient d'administrer oralement du kétoprofène (4.5 mg/kg PC) par voie orale pendant les 3 à 5 jours suivants. Le scrotum desséché y compris l'élastique doit être supprimé sans anesthésie au moyen d'un couteau propre ou d'un scalpel stérile 10 jours après la pose de l'élastique. Les agneaux doivent être castrés dans leurs 14 premiers jours de vie, comme les veaux avec un élastique posé au minimum 10 minutes après la réalisation d'une anesthésie à la lidocaïne. On prendra garde à ne pas dépasser la dose maximale de 4 mg/kg de lidocaïne (ce qui représente 1 ml de lidocaïne 2 % pour un agneau de 5 kg). Simultanément à l'anesthésie, on appliquera un AINS (reconversion) et un sérum antitétanique. La vaccination anti-GnRH représente une alternative pratique et économique ménageant les animaux pour la castration des veaux et des agneaux mâles. Une double vaccination à 3 à 4 semaines d'intervalle permet de bloquer le développement testiculaire pendant au moins 3 mois et de retarder ainsi la maturité sexuelle. Toutefois il n'existe actuellement pas en Suisse ni en Europe de vaccin spécifique enregistré pour l'application chez les ruminants.

[Methods of analgesia and euthanasia in backyard poultry]. / Methoden der Analgesie und Euthanasie in der Hobby-Hühnerhaltung.

INTRODUCTION: The keeping of chickens in the backyard is growing in popularity in urban and suburban areas, numbers of animals are increasing and as a result small animal practitioners are more and more frequently faced with chickens as patient. Clinical conditions in backyard poultry often require the treatment of pain. The challenges regarding the adequate use of analgesics include: 1. Recognition and assessment of pain, which necessitates good knowledge of chicken behaviour, 2. Selection of the adequate drug and dosage based on evidence that is often not available for chickens, but spread over different species of birds, and 3. Implementation of food safety regulations, which result from the dual use of backyard poultry as «food producing pets¼. Analgesics used in chickens include opiates, nonsteroidal anti-inflammatory drugs and local analgesics. The opiate butorphanol has been shown to have an analgesic effect of approximately two hours in chickens. Tramadol and methadone show some promise as analgesics, but more evidence is needed especially regarding bioavailability. The nonsteroidal anti-inflammatory drugs meloxicam and carprofen appear to have an analgesic effect. Variable metabolism between breeds of chickens and the risk of accumulation, especially when used for periods exceeding five consecutive days, need to be taken into account regarding dosage. Lidocaine and bupivacaine have successfully been used in chickens for nerve blocks and spinal anaesthesia and should be included as part of multimodal analgesia especially during surgery. In cases, where termination of life is necessary the preferred method consists of an injectable anaesthesia followed by intravenous application of a barbiturate.

INTRODUCTION: L'élevage de volailles de basse-cour est de plus en plus populaire dans les zones urbaines et suburbaines, le nombre d'animaux augmente et les praticiens pour petits animaux sont, par conséquent, de plus en plus souvent confrontés à ces animaux en tant que patients. Les conditions cliniques des volailles de basse-cour nécessitent souvent le traitement de la douleur. Les défis liés à l'utilisation adéquate des analgésiques sont les suivants 1. La reconnaissance et l'évaluation de la douleur, qui nécessitent une bonne connaissance du comportement des volailles, 2. la sélection du médicament et du dosage adéquats sur la base de preuves qui ne sont souvent pas disponibles pour les volailles mais sont réparties entre différentes espèces d'oiseaux, et 3. la mise en œuvre des réglementations en matière de sécurité alimentaire, qui résultent de la double utilisation des volailles de basse-cour en tant qu'«animaux de compagnie producteurs de denrées alimentaires¼. Les analgésiques utilisés chez les poulets comprennent les opiacés, les anti-inflammatoires non stéroïdiens et les analgésiques locaux. Il a été démontré que l'opiacé butorphanol a un effet analgésique chez les poulets, d'une durée d'environ deux heures. Le Tramadol et la méthadone sont des analgésiques prometteurs, mais des preuves supplémentaires sont nécessaires, notamment en ce qui concerne leur biodisponibilité. Les anti-inflammatoires non stéroïdiens Meloxicam et Carprofen semblent avoir un effet analgésique. En ce qui concerne la posologie, il convient de tenir compte du métabolisme variable selon les races de poules et du risque d'accumulation, en particulier en cas d'utilisation pendant des périodes supérieures à cinq jours consécutifs. La lidocaïne et la bupivacaïne ont été utilisées avec succès chez les poules pour les blocs nerveux ainsi que pour l'anesthésie spinale et devraient être incluses dans l'analgésie multimodale, en particulier pendant la chirurgie. Dans les cas où il est nécessaire de mettre fin à la vie de l'animal, la méthode de choix consiste en une anesthésie injectable suivie d'une application intraveineuse d'un barbiturique.

[The importance of a veterinary anaesthetist and pain treatment according to dog and cat owners]. / Bedeutung einer Veterinäranästhesistin oder eines Veterinäranästhesisten und einer optimalen Schmerztherapie aus Sicht von Hunde- und Katzenbesitzerinnen und -besitzer.

INTRODUCTION: In Switzerland, compared to the United Kingdom or the United States of America, fewer veterinary anaesthetists are employed in private practice, which raises the question about the reason. The present survey aimed at investigating the awareness of pet owners concerning the specialization of veterinary anaesthesia and the value they attribute to such a specialist. Also, estimation of pain in dogs and cats and the importance of its treatment from the point of view of the pet owners was analysed. Furthermore, the necessity of veterinary anaesthetists in private practice and the influencing factors were investigated. The survey was created on LimeSurvey, an online tool for questionnaires and sent to dog and cat owners of the small animal clinic of the University Hospital of Zurich. 317 fully completed questionnaires were evaluated. In general, pet owners appreciated the specialization of veterinary anaesthesiology. Great importance was attributed to the supervision of anaesthesia and analgesic therapy by a specialist. A preliminary talk with an anaesthetist would be appreciated. Owners would be willing to cover additional costs for a specialized anaesthetist, if recommended by the private veterinarian, and to bring their animal to the University Hospital, in case of an increased anaesthetic risk.

INTRODUCTION: En Suisse, les vétérinaires anesthésistes sont moins nombreux à exercer en cabinet privé qu'au Royaume-Uni ou aux États-Unis. La question se pose dès lors de savoir pourquoi il en est ainsi. Une enquête a analysé les connaissances des propriétaires d'animaux de compagnie sur la spécialisation de l'anesthésiologie vétérinaire et l'importance qu'ils accordent à un spécialiste en la matière. L'importance de la thérapie analgésique chez les chiens ou les chats a également été évaluée. En outre, le besoin en vétérinaires anesthésistes en pratique privée et les facteurs qui l'influencent ont été examinés. L'enquête a utilisé l'outil de questionnaire Lime-Survey et a été envoyée aux propriétaires de chiens et de chats de la Clinique des petits animaux de l'Université de Zürich. 317 questionnaires complétés ont été évalués. Les propriétaires d'animaux apprécient la spécialisation en l'anesthésiologie vétérinaire. Le vétérinaire anesthésiste est considéré comme très important dans les mesures anes-thésiques et la thérapie analgésique. Une consultation anesthésique préalable est souhaitée. Les propriétaires seraient disposés à prendre en charge les coûts supplémentaires de ce service ou, sur recommandation du vétérinaire privé, à amener leur animal à la Clinique pour petits animaux de l'Université de Zürich en cas de risque anesthésique accru.

[Pain after Shoulder Prosthesis Is Not Always Due to Infection or Loosening]. / Schmerz nach Schulterprothese ­ nicht immer Infekt oder Lockerung.

Pain after Shoulder Prosthesis Is Not Always Due to Infection or Loosening Abstract. Summary: Suprascapular nerve neuropathy is becoming increasingly recognized as a reason for persistent shoulder pain. The underlying cause may be iatrogenic, as in the case of our patient, or due to ganglionic compression or traction. Unfortunately, diagnosis and thus adequate therapy is frequently delayed. With this case study, we would like to bring the neuropathy of the suprascapular nerve into focus for the general practice.

[Prehospital Pain Management: Overview and Potential Improvements]. / Präklinische Schmerztherapie: Übersicht und Verbesserungsmöglichkeiten.

Prehospital Pain Management: Overview and Potential Improvements Abstract. Pain is a frequent issue in the prehospital setting. Rapid and adequate analgesia has a positive effect on the physiological and psychological condition of patients. However, up to 43 % of patients still suffer insufficient analgesia. Several studies have identified some factors that contribute to this problem; these factors can be patient- and intervention-specific or dependent on the staff on duty. In order to improve prehospital analgesia in the future, structural and organizational changes as well as the implementation of new methods and therapies are essential.

How painful are cats after neutering - a field study using multimodal analgesia with intraperitoneal ropivacaine in a -neuter-return program in feral cats.

INTRODUCTION: For a large-scale trap-neuter-return program 119 cats were anaesthetised with an intramuscular combination of 0,03-0,05 mg/kg medetomidine, 7-10 mg/kg ketamine and 0,4 mg/kg butorphanol. Cats received intraoperative 4 mg/kg tolfenamic acid subcutaneously and before closure of abdominal wall either 2 mg/kg ropivacaine (ROPI) intraperitoneal or saline (NaCl) in equal volumes. Pain was scored one, six and 20 hours postoperative with the modified Glasgow Composite Pain Scale (mGCPS) and the modified Colorado State University Scale (mCSU). There was no significant difference in the pain scores between the two groups, but the pain scores with both pain scales were significant higher (p < 0,001 for both) six hours compared to one and 20 hours postoperative. Cut-off value on the pain scales (necessitating rescue analgesia) was exceeded in 34,5 % for mGCPS and in 39,5 % for mCSU. Cats with a higher pain score showed a lower food intake (p .

INTRODUCTION: L'objectif de cette étude clinique prospective, randomisée, en aveugle et d'observation était d'étudier les effets de la ropivacaïne administrée par voie intrapéritonéale pour l'analgésie postopératoire chez des chats harets femelles subissant une ovariectomie. Dans le cadre d'un programme de piégeage, de stérilisation et de remise en liberté à grande échelle, 119 chattes ont été anesthésiées par une combinaison intramusculaire de 0,03 à 0,05 mg/kg de médétomidine, 7 à 10 mg/kg de kétamine et 0,4 mg/kg de butorphanol. Les chats ont reçu en peropératoire 4 mg/kg d'acide tolfénamique par voie sous-cutanée et, avant la fermeture de la paroi abdominale, 2 mg/kg de ropivacaïne (ROPI) par voie intrapéritonéale ou du sérum physiologique (NaCl) en volumes égaux. La douleur a été évaluée une, six et 20 heures après l'opération à l'aide de l'échelle de Glasgow de la douleur composite modifiée (mGCPS) et de l'échelle modifiée de l'Université d'État du Colorado (mCSU). Il n'y avait pas de différence significative dans les scores de douleur entre les deux groupes, mais les scores de douleur avec les deux échelles de douleur étaient significativement plus élevés (p < 0,001 pour les deux) six heures par rapport à une et 20 heures postopératoires. La valeur seuil des échelles de douleur (nécessitant une analgésie de secours) a été dépassée dans 34,5 % des cas pour le mGCPS et dans 39,5 % des cas pour le mCSU. Les chats ayant un score de douleur plus élevé ont présenté une prise alimentaire plus faible (p < 0,001). L'administration intrapéritonéale de ropivacaïne n'a pas amélioré significativement l'analgésie par rapport à une solution saline intrapéritonéale. La combinaison anesthésique couramment utilisée en pratique pour la stérilisation (médétomidine, kétamine, butorphanol), complétée par des médicaments analgésiques non stéroïdiens supplémentaires, a entraîné une analgésie postopératoire insuffisante 6 heures après la chirurgie chez plus d'un tiers des chats étudiés.

[Peripheral Regional Anaesthesia for Perioperative Analgesia]. / Periphere Regionalanästhesie oder Allgemeinanästhesie ­ eine individuelle Risiko-Nutzen-Abwägung.

Peripheral Regional Anaesthesia for Perioperative Analgesia Abstract. Peripheral regional anaesthesia is the actual gold standard of opioid-sparing perioperative analgesia and is mainly used for surgery of the shoulder, arm and leg. Well-trained anaesthesiologists are the prerequisite for the correct individual risk-benefit assessment and the performance of the nerve blocks using a combination of ultrasound guidance and peripheral nerve stimulation (dual guidance). The postoperative care of the patients requires trained staff.

[Neuropathic Pain - Differential Diagnosis and Treatment from the Hand Surgeon's Perspective]. / Neuropathische Schmerzen ­ Handchirurgische Differenzialdiagnose und Therapie.

Neuropathic Pain - Differential Diagnosis and Treatment from the Hand Surgeon's Perspective Abstract. Neuropathic pain of the wrist and hand can be caused by a multitude of pathologies, such as trauma, iatrogenic damage, local peripheral nerve compression, nerve tumors and systemic diseases. Neuropathic pain can lead to chronification and disability, severely affecting the patients' quality of life and the ability to work. A precise diagnosis is the key to an adequate therapy with satisfactory functional results. An interdisciplinary and multimodal approach is a prerequisite when treating neuropathic pain. This review article provides an insight into the diagnosis and therapy of pathologies associated with neuropathic pain of the wrist and hand.

[The Coupling of Pain, Anxiety, and Stress]. / Die Kopplung von Schmerz, Angst und Stress.

The Coupling of Pain, Anxiety, and Stress Abstract. There is considerable neurobiological, clinical and epidemiological evidence that the systemic phenomena of anxiety and pain closely interact. Both perceptions trigger stress activation processes and are in turn modulated by long-term stress. This overview illustrates the coupling of pain, anxiety and stress with some clinical examples. The relations shown here should help us to gain a holistic view of the individual patient and his/her psychosocial reality, in which nociceptive, affective and vegetative symptoms are often interdependent and mutually reinforcing each other.

[Bio-Psycho-Social Therapy for Stress-Induced Chronic Pain]. / Bio-psycho-soziale Therapie bei stressinduzierten Schmerzzuständen.

Bio-Psycho-Social Therapy for Stress-Induced Chronic Pain Abstract. Against the background of latest neurobiological and epigenetic findings the bio-psycho-social model of disease is outlined often misinterpreted in the context of chronic pain. It represents the basic principle for a personalized treatment of stress-induced chronic pain. Consequences for diagnostic procedures are delineated to detect this pathogenetic subgroup of chronic pain patients (e.g. fibromyalgia, back pain, temporomandibular dysfunction, tension headache). Finally, the principles of a bio-psycho-social treatment program with high efficiency are presented.

Moving towards Soul - an alchemical journey. Rehabilitation of women suffering from 'chronic pain' in a clinical and Jungian context.

The aim of this paper is to explore the connection between symptom and symbol in the body of women suffering from chronic pain, diagnosed as fibromyalgia. The working hypothesis has been that the symbol that emerges from the symptom in the body can bridge the gap to a deeper meaning of pain and suffering, thereby becoming the agent of change for healing of the bodymind and the experience of pain in the physical body. To explore this subject I will introduce some recent research from the field of fibromyalgia, and the concepts of agency and affect systems in the body, which are important cornerstones in my work. I will briefly present my clinical concept of 'Form and Freedom'. From this theoretical base I give some clinical examples of what I see as an alchemical journey towards soul, presented through vignettes, images and the words of three women - Maria, Riba and Ishtar. I conclude with how I see analytical psychology taking its rightful place alongside, informing or in conjunction with, as in my case, other psychotherapeutic modalities, working in creative ways that enhance healing in patients who suffer from chronic pain.

Le but de cet article est d'explorer le lien entre le symptôme et le symbole dans le corps de femmes souffrant de douleurs chroniques, diagnostiquées comme fibromyalgie. L'hypothèse de travail a été que le symbole qui émerge du symptôme dans le corps peut fournir une passerelle pour aller vers un sens plus profond de la douleur et de la souffrance, devenant ainsi l'élément du changement dans la guérison du corps-esprit et de l'expérience de la douleur dans le corps physique. Afin d'explorer ce sujet je présenterai des recherches récentes dans le champ de la fibromyalgie. Je présenterai aussi le concept des systèmes d'affect et d'éléments de changement dans le corps, qui sont des pierres angulaires dans mon travail. Je présenterai brièvement mon concept clinique « Forme and Liberté ¼. A partir de ce support théorique je donnerai quelques exemples cliniques de ce que je vois comme un voyage alchimique vers l'âme, ceci par des vignettes, images et paroles de trois femmes - Maria, Riba et Ishtar. Je conclue en évoquant comment je vois la psychologie analytique prendre sa place légitime parmi d'autres modalités psychothérapeutiques, informant celles-ci ou leur apportant simplement son concours, comme c'est le cas dans mon travail, travaillant de manière créative à soutenir la guérison chez des patientes souffrant de douleurs chroniques.

El objetivo de este trabajo es explorar la conexión entre síntoma y símbolo en el cuerpo de mujeres que padecen dolor crónico, diagnosticado como fibromialgia. La hipótesis de trabajo es que el símbolo que emerge desde el síntoma en el cuerpo puede tender un puente hacia un sentido más profundo del dolor y el sufrimiento, por lo tanto volviéndose un agente de cambio para la sanación del cuerpomente y la experiencia de dolor en el cuerpo físico. Para explorar este tema, voy a introducir algunas investigaciones recientes del campo de la fibromialgia, y los conceptos de sistemas de agencia y de emoción en el cuerpo, los cuales son piedras fundamentales en mi trabajo. Introduciré brevemente mi concepto clínico de 'Forma y Libertad'. A partir de esta base teórica, presento ejemplos clínicos de aquello que comprendo como un viaje alquímico hacia el alma, presentado a través de viñetas, imágenes y el trabajo de tres mujeres - María, Riba e Ishtar. Concluyo con mi percepción respecto a cómo la psicología analítica puede tomar su debido lugar, informando o en forma conjunta con, otras modalidades psicoterapéuticas, trabajando de maneras creativas para enaltecer la curación en pacientes que sufren de dolor crónico.

[Patient first - The impact of characteristics of target populations on decisions about therapy effectiveness of complex interventions: Psychological variables to assess effectiveness in interdisciplinary multimodal pain therapy]. / Patient first - Die Bedeutung spezifischer Zielpopulationscharakteristika für die Bewertung von Therapieeffektivität bei komplexen Interventionen: Psychologische Variablen in der Effektivitätsbestimmung interdisziplinärer multimodaler Schmerztherapie.

INTRODUCTION: The assessment of treatment effectiveness in public health settings is ensured by indicators that reflect the changes caused by specific interventions. These indicators are also applied in benchmarking systems. The selection of constructs should be guided by their relevance for affected patients (patient reported outcomes). The interdisciplinary multimodal pain therapy (IMPT) is a complex intervention based on a biopsychosocial understanding of chronic pain. For quality assurance purposes, psychological parameters (depression, general anxiety, health-related quality of life) are included in standardized therapy assessment in pain medicine (KEDOQ), which can also be used for comparative analyses in a benchmarking system. The aim of the present study was to investigate the relevance of depressive symptoms, general anxiety and mental quality of life in patients undergoing IMPT under real life conditions. METHODS: In this retrospective, one-armed and exploratory observational study we used secondary data of a routine documentation of IMST in routine care, applying several variables of the German Pain Questionnaire and the facility's comprehensive basic documentation. 352 participants with IMPT (from 2006 to 2010) were included, and the follow-up was performed over two years with six assessments. Because of statistically heterogeneous characteristics a complex analysis consisting of factor and cluster analyses was applied to build subgroups. These subgroups were explored to identify differences in depressive symptoms (HADS-D), general anxiety (HADS-A), and mental quality of life (SF 36 PSK) at the time of therapy admission and their development estimated by means of effect sizes. Analyses were performed using SPSS 21.0®. RESULTS: Six subgroups were derived and mainly proved to be clinically and psychologically normal, with the exception of one subgroup that consistently showed psychological impairment for all three parameters. The follow-up of the total study population revealed medium or large effects; changes in the subgroups were consistently caused by two subgroups, while the other four showed little or no change. In summary, only a small proportion of the target population (20 %) demonstrated clinically relevant scores in the psychological parameters applied. DISCUSSION: When selecting indicators for quality assurance, the heterogeneity of the target populations as well as conceptual and methodological aspects should be considered. The characteristics of the parameters intended, along with clinical and personal relevance of indicators for patients, should be investigated by specific procedures such as patient surveys and statistical analyses.

[Quantitative Sensory Testing in the facial area: a review]. / Quantitative Sensorische Testung im Gesichtsbereich - eine Übersicht.

Quantitative Sensory Testing is an established method to evaluate somatosensory function. In the facial area, the procedures depend on the localisation of disorders and the modalities of interest. The test stimuli are of thermal or mechanical nature (touch, pain, vibration, or pressure stimuli). According to the protocol of the German Neuropathic Pain Network, comprehensive information on the function of afferent nerves can be generated in the facial area as well. Standard values have been obtained for the cheek and intraoral mucosa. For various orofacial pain conditions, studies concerning the somatosensory function are available. Changed functional patterns are not limited to neuropathic pain, but also occur in other orofacial pain conditions, indicating, for example, central sensitisation. The standardised collection of QST parameters may improve the understanding of the pathophysiology of orofacial pain and effect therapeutic approaches. Comprehensive studies may lead to the development of specific screenings that are feasible in a clinical setting.

[The therapy of masticatory muscle pain with oral splints]. / Therapie von Kaumuskelschmerzen mit Okklusionsschienen.

Myofascial masticatory muscle pain is the second most frequent pain-related complaint in the orofacial region. Like unspecific musculoskeletal pain in other body segments, masticatory muscle pain is characterised by a multifactorial aetiology. The aim of this article is to document the current knowledge about the therapy with oral splints. It is shown that in both the short and long term, oral appliances can achieve sufficient pain relief in the majority of patients. In chronic myofascial jaw pain associated with psychosocial impairment in patients, effectiveness of splint therapy is limited, though. Within an interdisciplinary pain management programme, additional involvement of a psychotherapist is essential.