自体髓核介导兔腰神经根非机械性损伤的实验观察

目的观察兔自体髓核移植对腰神经根的损伤情况,分析其结构与功能改变的关系。方法将兔自体L2～3间盘的髓核在无压迫情况下移植于L7神经根处,对照组代以同等大小的自体脂肪组织。术后3,7,15,30d测量神经传导速度,观察神经根组织学结构改变。结果实验组3d(36±5)m/s,7d(31±4)m/s,15d(27±5)m/s,30d(34±6)m/s;对照组3d(47±8)m/s,7d(50±4)m/s,15d(52±5)m/s,30d(52±7)m/s,实验组神经传导速度明显低于对照组(t=-12,-21,-27,-14,P<0.01)。苏木精-伊红染色可见神经根水肿,炎性细胞浸润。结论自体髓核在无压迫情况下可造成神经根损伤;非机械性神经根损伤后,结构与功能的改变不平行,提示尚有其他因素影响神经根传导功能。     

兔腰神经根慢性压迫模型的建立

目的 :制作腰神经根慢性轻度压迫模型。方法 :取纯种新西兰成年兔 16只 ,将 4只做神经定位解剖 ,12只随机分成 3组 :10天组、30天组和 180天组 ,每组 4只。将长 12mm ,内径 1.5mm ,外径 2 .5mm的硅胶管从椎间外孔缓慢塞入兔椎间管内 ,压迫腰 6和腰 7左侧神经根 ,右侧为自身对照侧 ,硅胶管的截面积约为椎间管经关节突关节矢状面面积的 2 0 % ,约为椎间外孔面积的 5 0 %。结果 :10天组与 30天组比较 ,潜伏时明显延长 ,神经传导速度减慢。180天组虽然与对照侧比较潜伏时和神经传导速度均有显著性差异 ,但与 30天组比较已有明显改善。对照侧的潜伏时、神经传导速度各时间点均无明显差异。除 10天组潜伏时、神经传导速度与对照侧比较无明显差异外 ,30天组和 180天组潜伏时、神经传导速度与对照侧比较均有明显差异 ,潜伏时延长 ,神经传导速度减慢。结论 :将硅胶管从兔的椎间外孔缓慢塞入椎间管内使腰神经根慢性轻度受压 ,更接近于腰椎间盘突出和椎间管狭窄对神经根的压迫。慢性压迫后的神经有自行恢复的能力。     

自体髓核介导兔腰神经根非机械性损伤的实验观察

目的 观察兔自体髓核移植对腰神经根的损伤情况，分析其结构与功能改变的关系。方法 将兔自体L2-3间盘的髓核在无压迫情况下移植于L7神经根处，对照组代以同等大小的自体脂肪组织。术后3，7，15，30d测量神经传导速度，观察神经根组织学结构改变。结果 实验组3d(36&;#177;5)m/s,7d(31&;#177;4)m/s,15d(27&;#177;5)m/s,30d(34&;#177;6)m/s；对照组3d(47&;#177;8)m/s,7d(50&;#177;4)m/s,15d(52&;#177;5)m/s，30d(52&;#177;7)m/s，实验组神经传导速度明显低于对照组（t=-12,-21,-27,-14,P&;lt;0.01）。苏木精-伊红染色可见神经根水肿，炎性细胞浸润。结论 自体髓核在无压迫情况下可造成神经根损伤；非机械性神经根损伤后，结构与功能的改变不平行，提示尚有其他因素影响神经根传导功能。     

面神经分支传导速度的临床和实验研究

目的:通过神经传导速度不同的测试,进一步阐述眼轮匝肌支配神经(简称:眼支)和口轮匝肌支配神经(简称:口支)受损伤程度差异的原因,为面肌功能评价的“局部评价系统”的确立提供依据。方法:应用肌电图仪计测正常人眼支、口支的潜伏时及豚鼠眼支、口支的潜伏时,进一步计算出传导速度。结果:正常人眼支传导速度为(42.3±6.1)m/s,口支为(28.4±3.3)m/s,两支传导速度差异有极显著性意义(P<0.001)。实验前,豚鼠眼支传导速度为(21.1±3.1)m/s,口支为(15.5±3.0)m/s。两支传导速度间差异有极显著性意义(P<0.001)。压迫豚鼠面神经前后眼支传导速度差值为(3.3±0.6)m/s,口支为(1.2±0.1)m/s,两支间的差异有极显著性意义(P<0.001)。结论:眼支和口支具有传导速度差异的生理学特点,支持面肌功能评价“局部评价系统”的合理性。     

应用神经传导速度评估振源胶囊对糖尿病患者肢体疼痛及麻木症状的改善效应

目的:探讨以人参果实总皂甙类中药地精子为主要成分的振源胶囊对糖尿病周围神经病变神经传导速度和肢体疼痛麻木症状的影响。方法:纳入2001-04/2003-08在广西医科大学第一附属医院中医科门诊就诊的Ⅱ型糖尿病患者90例,均符合糖尿病周围神经病变诊断标准。按随机表法分为两组:观察组45例,对照组45例。观察组给予口服振源胶囊(主要成分为人参果实总皂甙),2粒/次,3次/d,连用4周;对照组用维生素B1100mg,维生素B120.25mg,肌肉注射,1次/d,连用4周。①采用神经症状的评分和神经体征检查评分评价患者的周围神经症状。患者有针刺样痛,刀割样痛,异常冷热和烧灼感症状之一为1分,或夜间加重为2分,总分大于或等于3分为异常;双下肢的触觉,痛觉用尼龙单线检查,震颤觉用120Hz的音叉检查,无异常者至损害局限在膝关节分为0～5分,膝反射、踝反射正常为0分,增强引出为1分,消失为2分,总分大于或等于5分为异常。②采用丹麦KEYPOINT肌电仪测定正中神经、腓总神经的运动神经传导速度和感觉神经传导速度。观察治疗前后症状及体征改善情况及正中神经、腓总神经的运动神经传导速度、感觉神经传导速度。结果:参与实验的90例糖尿病患者全部进入结果分析。①用药后观察组和对照组患者疗效比较:观察组在症状及体征方面的改善明显优于对照组(2.6±0.4,4.0±0.3,t=18.7830,P<0.01;5.9±0.4,7.0±0.2,t=16.500,P<0.05)。②观察组和对照组治疗前后神经传导速度变化比较:组内比较,观察组用药后运动神经(正中神经,腓总神经)、感觉神经(正中神经,腓总神经)传导速度较用药前均明显增快([46±6,36±4;46±6,32±4;50±6,42±6;49±5,41±5)m/s,t=9.3026,13.0236,6.3246,7.5895,P<0.05];对照组用药后运动神经(正中神经)、感觉神经(正中神经)传导速度较用药前均明显增快([39±3,34±5;45±5,40±4)m/s,t=5.7522,P<0.05;t=47.1440,P<0.01]。组间比较,用药后观察组运动神经(正中神经,腓总神经)、感觉神经(正中神经,腓总神经)传导速度均明显优于对照组[(46±6,39±3;46±6,38±4;50±6,45±5;49±5,42±3)m/s,t=7.0000,7.4421,4.2945,8.0531,P<0.05～0.01]。结论:振源胶囊能明显改善糖尿病周围神经病变的症状、体征,对提高周围神经传导速度具有良好的作用。     

腰椎间盘突出后神经传导速度改变的自然过程

目的:评价腰椎间盘突出后神经传导速度的变化。方法:实验于2002-03/2003-05在中国医科大学中心实验室完成。将75只健康杂种犬(雌雄不限,体质量9～12kg)随机分为正常对照组(n=4)、假突出组(n=31)和椎间盘突出组(n=40)。通过切除左侧L7椎板上部分和L6椎板下部分来暴露脊髓。假突出组L7神经根被轻柔的缩回;椎间盘突出组在回缩期间注入生理盐水造成椎间盘突出及髓核物质漏入椎管内。假突出组和椎间盘突出组按观察时间分别分为3,7d,1个月,2个月组。正常对照组仅作神经生理学评价,提供神经根传导速度的基线数据。神经传导速度评估采用L6～L7神经根刺激后刺激电压2～4V,持续时间1ms)描记同侧腓肠肌动作电位的方法。比较各组实验动物不同时间点的神经传导速度。结果:75只动物均进入结果分析。椎间盘突出组的神经传导速度在椎间盘突出后3d40±9)ms开始下降,至7d(18±11)ms时下降达最大值,明显低于假突出组3d(50±14)ms、7d(30±8)ms和正常对照组3d(68±11)ms、7d(68±10)ms的神经传导速度(t=2.33～8.91,P<0.001～0.01);椎间盘突出组1个月后神经传导速度(65±10)ms与假突出组(68±9)ms只有很小的差别(t=0.53,P>0.05);2个月后椎间盘突出组(70±9)ms和假突出组(70±11)ms的神经传导速度基本相同(t=0.00,P>0.05);且与     

神经电刺激对面神经端侧吻合后神经再生的影响

目的探讨神经电刺激对周围面神经端侧吻合后促神经再生的作用。方法将24只成年家兔随机分为3组,兔双侧面神经颊支切断后与同侧外膜开窗的颈支作端侧吻合。右侧为实验侧,术后给予神经电刺激,共5周;左侧不给电刺激,作为对照侧。分别于术后3,5,15周取材,进行神经组织学、电生理和透射电镜等检查。结果各组实验侧颊支有髓神经数犤术后3,5,15周组分别为(65.32±6.36),(71.53±7.89),(81.62±8.63)个/高倍视野犦均高于对照侧犤术后3,5,15周组分别为(45.28±5.13),(59.68±4.26),(65.87±3.84)个/高倍视野犦,检测术后15周组颊神经的运动神经传导速度,结果实验侧神经传导速度为(28.6±1.4)m/s,而对照侧为(17.2±2.6)m/s,两者差异有显著意义(t=2.852,P<0.05);实验侧颊支神经成熟程度优于对照侧。结论神经电刺激在提高神经端侧吻合后侧支萌出率和减轻失神经肌肉萎缩方面有积极作用。     

应用神经肌电图评估奇经全息法对糖尿病周围神经病变患者神经传导速度的影响

目的:观察奇经全息诊疗配脉络宁注射液对糖尿病周围神经病变患者神经传导速度的改善作用,探讨其作用机制。方法:将60例患者随机分为治疗组、对照组各30例,治疗组予奇经全息诊疗法并脉络宁注射液40mL静脉点滴;对照组30例,予弥可保片,治疗前和治疗满疗程后,采用DISA2500C型肌电图仪,对两组患者进行正中神经、腓总神经的运动神经传导速度,正中神经、腓浅神经的感觉神经传导速度测定。结果:治疗组显效19例,有效7例,无效4例,总有效率87%(26/30),对照组显效3例,有效9例,无效18例,总效率40%(12/30)。两组总有效率比较(χ2=14.07,P<0.01)。治疗组治疗后正中神经、腓总神经的运动神经传导速度及正中神经、腓浅神经的感觉神经传导速度分别为(47.8±8.8)m/s,(44.3±6.4)m/s,(45.2±5.7)m/s,(34.9±6.3)m/s与治疗前(41.8±3.8)m/s,(39.5±4.2)m/s,(39.7±5.8)m/s,(29.8±5.8)m/s比较(t'=3.43,3.43,P<0.05;t=3.71,3.26,P<0.01)。与对照组治疗后比较(t=0.85～1.69,P<0.01)。结论:奇经全息诊疗配脉络宁能有效改善糖尿病周围神经病变患者神经传导速度和症状及体征。     

俞募配穴针刺法对糖尿病周围神经病变患者神经传导速度的影响

目的:探讨针刺治疗糖尿病周围神经病时,配穴方法与神经传导速度的关系。方法:选取2003-01/2004-05在首都医科大学宣武医院内分泌科门诊糖尿病周围神经病变患者中,符合纳入标准,能够完成治疗所需疗程的100例患者,根据就诊顺序,每满25例一组,分别为治疗组Ⅰ,治疗组Ⅱ,治疗组Ⅲ和对照组。治疗组Ⅰ取穴:第1组:大椎、肺俞、肝俞、脾俞、胃腧、肾俞、悬钟、太溪、行间、然谷。第2组:关元、中府、期门、章门、中脘、京门、曲池、合谷、血海、足三里、三阴交。治疗组Ⅱ取穴同治疗组Ⅰ的第1组腧穴。针具选择及针刺手法同治疗组Ⅰ。治疗组Ⅲ取穴同治疗组Ⅰ的第2组腧穴。操作同治疗组Ⅱ。对照组:仅药物治疗。检查并记录各组治疗前后的神经传导速度,进行比较。结果:治疗组Ⅰ治疗后运动神经传导速度犤正中神经(40.6±3.4)m/s,胫后神经(37.0±3.2)m/s犦、感觉神经传导速度犤正中神经(46.4±3.6)m/s,胫后神经(37.0±3.9)m/s犦明显高于治疗前犤(34.7±2.9),(30.2±3.0),(41.1±3.1),(32.4±3.3)m/s犦(t=6.556,7.753,5.579,4.51,P<0.01)。对照组治疗前后神经传导速度比较,差异无显著性意义(P>0.05)。治疗组I治疗后感觉、运动神经传导速度明显高于治疗组Ⅱ,Ⅲ治疗后(t=3.115～4.390,P<0.01)。结论:俞募配穴针刺法能有效改     

高压氧对糖尿病患者周围神经传导速度的影响

目的:探讨高压氧治疗对糖尿病并发周围神经病患者周围神经传导速度(nerveconductionvelocity,NCV)的影响,并将运动神经和感觉神经的结果予以分析比较。方法:糖尿病患者69例随机分为两组,对照组31例采用糖尿病饮食、降血糖、能量合剂、促代谢药物等治疗,治疗组38例在上述治疗的基础上加用高压氧治疗。采用多人高压氧舱,在舱内停留100min,压力0.20MPa,戴面罩吸入纯氧60min,中间休息10min,1次/d,10d为1个疗程,共3个疗程,疗程间隔2～4d。分别于治疗前、治疗2个月后测定正中神经、尺神经、胫神经的NCV并进行比较。结果:治疗组治疗前后正中神经的运动神经传导速度(MNCV)分别为(40.9±5.6)m/s,(43.9±4.7)m/s,差异有非常显著性意义(P<0.01)、感觉神经传导速度(SNCV)分别为(41.2±4.9)m/s,(43.4±5.2)m/s,差异有非常显著性意义(P<0.01),尺神经MNCV分别为(42.3±4.1)m/s,(45.5±7.4)m/s,差异有非常显著性意义(P<0.01),SNCV分别为(40.6±5.3)m/s,(42.2±4.7)m/s,差异有显著性意义(P<0.05),胫神经MNCV分别为(41.9±7.8)m/s,(43.5±5.1)m/s,差异有显著性意义(P<0.05),SNCV分别为(39.7±5.4)m/s,(41.9±4.8)m/s,差异有非常显著性意义(P<0.01);对照组治疗后仅正中神经的MNCV、尺神经的MNCV显著加快;治疗前组间比较差异     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.