Alltagsdeutungen und medizinische Deutungen von Kopfschmerzen und Migräne

Background

Every professional segment has its own typical forms of stress, which for members result in patterns of bodily conception and interpretation of pain. The way individuals cope with these typical forms of pain reflects their social identity, social status and group membership. In this study pain was investigated from a sociological perspective as a medium contributing to socialization processes in stress collectives.

Objectives

Cultural conceptions of headache and migraine were investigated in members of blue collar occupations, in service professions and patients in specialized medical pain care.

Materials and methods

In this study 49 qualitative biographical interviews were conducted with patients suffering from headache and migraine. The study population included persons from the general outpatient population and patients recruited from specialized inpatient pain clinics.

Results

Members of blue collar occupations with specific body-oriented, mechanical stress patterns and dominant masculine attitudes, perceived headache and migraine as atypical deviations, which are contextualized as body pain. Professionals in the service sector with specific communicative-emotional work patterns perceived headache and migraine as typical and accepted deviations. Both pain conceptions represent dominant body norms and social commitments in each group; however, in specialized pain care these everyday concepts are transformed by increasing expert knowledge resulting in medicalized life styles and in identity conceptions conforming to the medical imperative.

Conclusion

The success of specialized treatment of headache depends to a certain extent on the ability of patients to impose a medically regulated life style on their significant others; however, this can conflict with the demands of everyday life.

     

Prävalenz und Risikofaktoren von Phantomschmerzen und Phantomwahrnehmungen in Deutschland

Background

Data on the incidence and intensity of phantom limb pain (PLP) and phantom limb sensations (PLS) were collected in a nationwide survey.

Materials and methods

Supported by a manufacturer of artificial limbs and press notices a total of 537 amputees were contacted and interviewed by questionnaire.

Results

The questionnaire containing 62 questions was filled in by 537 out of 1,088 amputees. Of the amputees 14.8% were pain free, 74.5% had PLP, 45.2% stump pain (SP) and 35.5% a combination of both. In addition 62.4% of the amputees reported disturbed sleep, of those with PLP it was even higher at 77.3% and 66.8% of patients with PLP woke up several times during the night. The prevailing features of PLP included burning sensation (13.6%), cramp (15.3%), prickling (23.4%), electrification (21%) and tingling (20.4%). Phantom sensations were felt by 73.4% and were described as being mobile (66.8%), of normal temperature (64%), warm (19.5%), cold (16.5%), bare (35.9%), clothed (13.6%), not unpleasant (31.7%), pressed (29.6%), contorted (7.5%) and blown up (5.8%). Of the patients with PLP, 35.7% described the location as mostly ventral, 26.7% as mostly dorsal. Significantly more PLP was found in the presence of PLS than in its absence (p <0.0001), but unrelated to the type of PLS, to demographic factors, or to the level or side of amputation. Perception of the artificial limb being “a foreign body” was highly significantly more often associated with PLP than with a sensation of “fusing with the body” (p <0.0001).

Conclusion

To our knowledge the present study constitutes the largest field survey on phantom limb pain carried out in Europe and corroborates the high prevalence and intensity of PLP, unusual PLS and amputation-related sleep disturbances. The significance and manageability of phantom feelings and its risk factors need further research.     

Subjektive Belastung und Religiosität bei chronischen Schmerzen und Brustkrebs

Background

Studies show that especially ill people turn to their religious faith to find help in dealing with their diseases. However, religiousness is assumed to vary in its extent and effect depending on different kinds of strain.

Material and methods

In order to differentiate patterns of strain and coping, a sample of 178 patients with chronic pain was compared with 167 breast cancer patients.

Results

Pain patients show higher strain and impairment on almost all variables. Regression analyses indicate that patients with chronic pain are less religious in comparison to the breast cancer patients.

Conclusions

Different values of the religious variables can be explained by different characteristics of the strain: Due to the threat to life experienced by the patients, the breast cancer group is more likely to turn to religiousness for help. Specific characteristics of chronic pain (e.g. longer illness duration, a stronger impairment in everyday activities) lead to higher resignation, also concerning religious efforts.     

Behandlung von übelkeit und Erbrechen mit Prokinetika und Neuroleptika bei Palliativpatienten

Background

Many recommendations concerning the treatment of nausea and vomiting in palliative care patients exist but what is the evidence for this? Most studies dealing with this topic have focused on cancer patients under chemotherapy and/or radiation therapy or on patients with postoperative nausea. Cancer patients without chemotherapy or radiation therapy, patients without postoperative nausea, and patients having other diseases with palliative care aspects, such as acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), progressive heart failure, amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) have been underrepresented in studies on nausea and vomiting so far.

Objectives

The aim of this review was to determine the level of evidence for the treatment of nausea and vomiting with prokinetics and neuroleptics in palliative care patients suffering from far advanced cancer and no longer being treated with chemotherapy or radiation therapy, AIDS, COPD, progressive heart failure, ALS or MS.

Methods

Two different electronic databases (PubMed und Embase) were used to identify studies. Furthermore, a hand search for related articles was performed. No restriction was made concerning study types. Studies with patients undergoing chemotherapy radiation therapy or suffering from postoperative nausea, pediatric studies and studies published neither in English nor in German were excluded.

Results

A total of 30 studies fulfilling the inclusion criteria were found. All studies focused on cancer patients. Despite intensive research studies in patients with AIDS, COPD, heart failure, ALS or MS were not detected. Metoclopramide is seen as an effective drug in many studies whereas the evidence for it is moderate at best. Within the group of neuroleptics, levosupiride and levomepromazine seem to have good antiemetic potential but the evidence level is low.

Conclusion

In patients with advanced cancer not being treated with chemotherapy or radiation therapy, metoclopramide can be used to reduce nausea and vomiting. Neuroleptics, such as levosulpiride or levomepromazine are alternatives but their adverse effects have to be considered carefully. The evidence level for prokinetics and neuroleptics is moderate to low. Concerning palliative care of patients with diseases other than cancer no studies exist. More well designed studies in palliative care patients are needed in order to facilitate evidence based antiemetic therapy. The English full text version of this article will be available in SpringerLink as of November 2012 (under “Supplemental”).     

Multimodale Komplexbehandlungen und Funktionstherapien für Kinder und Jugendliche mit Zerebralparese

Background and objective

Infantile cerebral palsy (ICP) is the most common cause of spastic syndromes in children and adolescents. It is caused by damage to the developing central nervous system. The structural damage is irreversible, but secondary functional disturbance of the loco motor system can be influenced by treatment. Since the functional problem is very often complex, different function-orientated multimodal treatment concepts (FMTC) have been developed for this patient group. In this review, the scientific evidence for these complex treatment programs is presented and discussed.

Methods

A literature search was conducted in the US National Library of Medicine, and a manual search in the Manuelle Medizin journal.

Results

A total of 57 relevant studies were found, of which 6 addressed FMTC. The other studies examined individual treatments frequently used in FMTC. Positive scientific evidence was found for all treatments. FMTC positively influenced patients’ motoric development.

Conclusion

FMTC and the functional treatments used in these programs positively influence development of the locomotor system in children and adolescents with ICP. Further studies are needed to assess the long-term sustainability of these effects.

     

Definition, Diagnostik und Therapie von chronischen Schmerzen in mehreren Körperregionen und des sogenannten Fibromyalgiesyndroms bei Kindern und Jugendlichen

Background

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies (“Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften”, AWMF; registration number 041/004) was planned starting in March 2011.

Materials and methods

The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy (“Deutsche Interdisziplinären Vereinigung für Schmerztherapie”, DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.

Results and conclusion

The diagnosis FMS in children and adolescents is not established. In so-called juvenile FMS (JFMS) multidimensional diagnostics with validated measures should be performed. Multimodal therapy is warranted. In the case of severe pain-related disability, therapy should be primarily performed on an inpatient basis. The English full-text version of this article is available at SpringerLink (under “Supplemental”).     

Cannabinoide—Signaltransduktion und Wirkung

The therapeutic use of cannabinoids, the components of cannabis sativa L., was investigated in numerous researches in detail. Animal studies revealed that cannabinoid receptor agonists alter pain-associated behaviour, have immune-suppressive properties, suppress tumor growth, modulate sensitisation processes and influence memory and learning. Those effects are mediated by two membrane-bound cannabinoid receptors and as mechanisms of signal transduction blockade of ion channels, inhibition of adenylate cyclase and retrograde inhibition of neurotransmitter release are currently being discussed.In clinical studies oral administration of cannabinoids indicated beneficial results during the therapy of multiple sclerosis, weight loss, nausea and vomiting due to chemotherapy, and intractable pruritus. However, therapy of chronic pain conditions revealed conflicting results and unequivocal success could not have been delivered due to unwanted side effects. Further multicentre studies are required to estimate cannabinoids as novel therapeutic tools for the treatment of chronic pain.     

Komplexitätstheorie und Manualmedizin

Zusammenfassung  Ausgehend von Fallbeobachtungen wird dargestellt, dass die teils sehr unterschiedlichen Effekte manueller Therapie (MT) am besten verständlich sind, wenn man 2 unterschiedliche Wirkungsweisen unterscheidet. Diese Differenzierung in robuste und subtile MT ermöglicht es, beide Behandlungstypen effizienter einzusetzen. Komplexitätstheoretische Konzepte und die Theorie des intelligenten Organismus werden zur Erklärung dieser Effekte erläutert und diskutiert.

Arzneimittelversorgung und Kostend?mpfungspolitik

Zusammenfassung  Nach 3 Jahrzehnten Kostendämpfungspolitik im deutschen Gesundheitswesen scheinen mit dem GKV-Modernisierungsgesetz (GMG) die Einsparpotentiale im Arzneimittelsektor weitestgehend ausgeschöpft worden zu sein. Die in der Strukturkomponente zum Ausdruck kommende Dynamik neuer, häufig hochpreisiger Produkte ist indes ungebrochen—auch nach der Einführung von Festbeträgen der Stufe 2 unter Einschluss von sog. Analogpräparaten.Eine differenziertere Evaluation pharmazeutischer Produkte aufgrund der Relation von zusätzlichem Nutzen zu zusätzlichen Kosten wird nur mit Hilfe gesundheitsökonomischer Analysen gelingen. Mit dem GMG wurde deren Einführung jedoch verworfen und damit eine Chance verpasst, die kontraproduktive sektorale Budgetierung zu überwinden. Internationale Erfahrungen begründen die Erwartung, dass auch mit diesem Instrument einer intelligenteren Differenzierung in Zukunft steigende Ausgaben für Arzneimittel wahrscheinlich sind.Eine weitere Verschärfung der Politik sektoraler Begrenzung der Arzneimittelausgaben wäre geeignet, nicht nur zu wachsender Ineffizienz aufgrund von Unterversorgung mit wirksamen Medikamenten zu führen, sondern u. U. auch zu dynamischer Ineffizienz („2. Ordnung“) und deshalb gesellschaftlichen Verlusten aufgrund reduzierter Ausgaben für pharmazeutische Forschung und Entwicklung beizutragen.* Nach einem Vortrag anlässlich eines Wissenschaftlichen Symposiums, veranstaltet von Vorstand und Ausschuss der Deutschen Gesellschaft für Innere Medizin und der Korporativen Mitglieder am 27. 10. 2004 in Wiesbaden zum Thema: Wohin führt die Gleichschaltung von Innovation und Imitation?     

Schlafmedizin und lebensqualität

Ohne Zusammenfassung

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An?sthesiologie und Palliativmedizin

Background

Anesthesiology departments were often integrated into the primary formation of palliative activities in Germany. The aim of this study was to present the current integration of anesthesiology departments into palliative care activities in Germany.

Methods

The objective was to determine current activities of anesthesiology departments in in-hospital palliative care. A quantitative study was carried out based on a self-administered structured questionnaire used during telephone interviews.

Results

A total of 168 out of 244?hospitals consented to participate in the study and the response rate was 69%. In-hospital palliative care activities were reported for most of the surveyed hospitals. Only two hospitals in the maximum level of care reported no activities. Participation in these activities by anesthesiology departments was described in up to 92%. Historically, most activities are due to the commitment of individuals, whereas the development of palliative care of cancer pain services and hospital support teams took place in the university hospitals by 2005.

Conclusions

Until 2005 many university palliative care activities had their origins in cancer pain services. These were often integrated into anesthesiology departments. Currently, anesthesiology departments work as an integrative part of palliative medicine. However, it appears from the present results that there is a domination of internal medicine (especially hematology and oncology) in palliative activities in German hospitals. This allows the focus of palliative activities to be formed by subjective specialist interests. Such a state seems to be reduced by the integration of anesthesiology departments because of their neutrality with respect to faculty-specific medical interests. Advantages or disadvantages of these circumstances are not considered by the present investigation.     

Wirbelsäule und Sport

Background

Adequate treatment of athletes with spine complaints presupposes knowledge of the particular sport-specific stress patterns on one hand, and potentially spinal column-damaging movements on the other.

Purpose

The present work is primarily intended to present biomechanical principles and thus provide information on the motion sequences that can potentially cause damage to the spine.

Material and methods

The present literature was reviewed using PubMed and Google Scholar, as well as orthopaedic textbooks. Further references to older literature were investigated using the Google search function and the central library of the Medical University of Vienna.

Results

Special changes in the spine are most present in the performance sport sector, and especially in the case of power sports. Pure axial loads hardly lead to detectable lesions, but in combination with flexion, extension or rotation, damage is possible. The juvenile spine reacts particularly sensitively to singular and repetitive stresses.

Conclusions

Significant lesions of the vertebral column are found primarily in performance athletes; they are observed less frequently with leisure time sports and health-related exercise. However, the potentially damaging effects of regular physical activity on the spine are far outweighed by the positive effects on the whole organism.