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ABSTRACT: HintergrundZiel dieser Arbeit war es, einen Einblick in die aktuell von behandelnden Ärzten verwendeten Therapieoptionen zu geben und
ihre Einschätzung zum Problem des chronischen Ischämieschmerzes zu untersuchen.
MethodenInsgesamt wurden 281Ärzte verschiedener Fachrichtungen befragt, die Patienten mit chronischen Ischämieschmerzen behandeln.
Die meisten der befragten Ärzte waren als Chirurgen, Internisten und Schmerztherapeuten tätig.
ErgebnisseFür die Behandlung chronischer Ischämieschmerzen wurde meist eine medikamentöse Schmerztherapie (Metamizol/Paracetamol, schwache
und starke Opioide) verwendet. Es zeigten sich Unterschiede zwischen den Fachgruppen. So wurden beispielsweise Antidepressiva
und Antikonvulsiva von Schmerztherapeuten deutlich häufiger verwendet. Auch bei der Beurteilung der Therapie gab es deutliche
Unterschiede: 57% der Chirurgen hielten die vorhandenen symptomatischen Therapieoptionen für ausreichend, während nur 21%
der Schmerztherapeuten dieser Meinung waren.
SchlussfolgerungDie deutlichen Unterschiede zwischen den Fachgruppen und die mehrheitlich als nicht ausreichend bezeichneten Therapiemöglichkeiten
weisen auf die Notwendigkeit hin, die symptomatische Therapie beim Ischämieschmerz in einem interdisziplinären Rahmen zu überdenken.
BackgroundThe intention of this study was to determine the status quo of commonly used pain therapies amongst treating physicians of
different specialties and to examine their view on the problem of chronic ischemic pain.
MethodsA total of 281 physicians treating patients with chronic ischemic pain were surveyed. The surveyed physicians were mainly
specialists in the fields of surgery, pain therapy, and internal medicine.
ResultsMainly a pharmacological therapy (metamizol/paracetamol, weak and strong opioids) was used in the treatment of chronic ischemic
pain. We found differences between the specialties, for instance pain specialists used antidepressants and anticonvulsants
more often than others. Therapeutic options were also evaluated differently by surgeons, pain therapists, and internal specialists:
57% of the surgeons considered the available symptomatic treatment options as sufficient whereas only 21% of the pain specialists
agreed with that opinion.
ConclusionThe differences among the specialties and the fact that the majority of physicians characterized the available symptomatic
treatment options as insufficient point towards a need to review the treatment of ischemic pain in an interdisciplinary approach.
Der Schmerz 04/2012; 22(2):164-170. · 0.88 Impact Factor
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ABSTRACT: HintergrundEine neuropathische Komponente chronisch ischämischer Schmerzen bei peripherer arterieller Verschlusskrankheit (PAVK) konnte
bereits mittels Quantitativer Sensorischer Testung (QST) und Fragebögen gezeigt werden. Ziel dieser Arbeit ist es, Zusammenhänge
zwischen Schmerzfragebögen und QST bei Patienten mit chronischen Ischämieschmerzen zu untersuchen.
MethodenZehn Patienten mit schwerer PAVK ohne begleitenden Diabetes mellitus füllten einen standardisierten Fragebogen aus und wurden
mittels QST untersucht. Der Fragebogen bestand aus verschiedenen validierten Befragungsinstrumenten zu Schmerzstärke, Schmerzqualität
und neuropathischen Schmerzen (VAS, SF-MPQ, S-LANSS, NPSI).
ErgebnisseEinige Wörter des SF-MPQ zeigten eine Korrelation mit Parametern der QST, so z.B. zwischen Allodynie und dem Wort empfindlich mit 0,911 (Korrelationskoeffizient nach Spearman; p ≤0,001). Der Subscore evozierter Schmerz des NPSI korrelierte mit dem QST-Parameter wind-up ratio mit 0,683 (p=0,042).
SchlussfolgerungUnsere Ergebnisse zeigen, dass Zusammenhänge zwischen psychophysikalischen Tests (QST) und Schmerzfragebögen existieren könnten.
Die gezeigten Zusammenhänge zwischen QST und Schmerzbeschreibung können dazu beitragen, die pathophysiologischen Mechanismen
aufzuklären, die zur Schmerzwahrnehmung führen.
BackgroundA neuropathic component to chronic ischemic pain in peripheral arterial disease (PAD) has recently been shown using quantitative
sensory testing (QST) and pain questionnaires. The aim of this study was to examine correlations between QST and pain questionnaires
in patients with chronic ischemic pain.
MethodsA total of 10 patients with severe PAD (Fontaine stages III and IV) without diabetes mellitus answered a questionnaire and
were examined with QST. The questionnaire consisted of several validated instruments which were used to examine the intensity
of pain, quality of pain and neuropathic pain (VAS, SF-MPQ, S-LANSS, NPSI).
ResultsThe results of the QST confirmed previously published data. Several terms of the SF-MPQ showed a correlation with parameters
of the QST, such as Allodynia (QST) which correlated with the term tender (SF-MPQ) (Spearman’s correlation coefficient 0.911; p≤0.001) and the NPSI subscore evoked pain correlated with the QST parameter wind-up ratio (0.683; p=0.042).
ConclusionThe results suggest that there might be correlations between psychophysical tests (QST) and pain questionnaires. Subjective
perceptions of pain might be represented by a certain pattern in the QST. These connections could contribute to further clarify
the pathophysiologic mechanisms leading to the perception of pain.
Der Schmerz 04/2012; 23(3):251-258. · 0.88 Impact Factor
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ABSTRACT: A neuropathic component to chronic ischemic pain in peripheral arterial disease (PAD) has recently been shown using quantitative sensory testing (QST) and pain questionnaires. The aim of this study was to examine correlations between QST and pain questionnaires in patients with chronic ischemic pain.
A total of 10 patients with severe PAD (Fontaine stages III and IV) without diabetes mellitus answered a questionnaire and were examined with QST. The questionnaire consisted of several validated instruments which were used to examine the intensity of pain, quality of pain and neuropathic pain (VAS, SF-MPQ, S-LANSS, NPSI).
The results of the QST confirmed previously published data. Several terms of the SF-MPQ showed a correlation with parameters of the QST, such as Allodynia (QST) which correlated with the term tender (SF-MPQ) (Spearman's correlation coefficient 0.911; p< or =0.001) and the NPSI subscore evoked pain correlated with the QST parameter wind-up ratio (0.683; p=0.042).
The results suggest that there might be correlations between psychophysical tests (QST) and pain questionnaires. Subjective perceptions of pain might be represented by a certain pattern in the QST. These connections could contribute to further clarify the pathophysiologic mechanisms leading to the perception of pain.
Der Schmerz 03/2009; 23(3):251-4, 256-8. · 0.88 Impact Factor
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ABSTRACT: Enhancement of membrane K(+) conductance may reduce the abnormal excitability of primary afferent nociceptive neurons in neuropathic pain. It has been shown that retigabine, a novel anticonvulsant, activates Kv7 (KCNQ/M) channels in the axonal/nodal membrane of peripheral myelinated axons. In this study, we have tested the effects of retigabine on excitability parameters of C-type nerve fibers in isolated fascicles of human sural nerve. Application of retigabine (3-10 microM) produced an increase in membrane threshold. This effect was pronounced in depolarized axons and small in hyperpolarized axons. This finding indicates that retigabine produces a membrane hyperpolarization which is limited by the K(+) equilibrium potential. The retigabine-induced reduction in excitability was accompanied by modifications of the post-spike recovery cycle. Most notable is the development of a late subexcitability at 250-400 ms following a short burst of action potentials. All effects of retigabine were blocked in the presence of XE991 (10 microM). The data show that Kv7 channels are present on axons of unmyelinated, including nociceptive, peripheral human nerve fibers. It is likely that activation of these channels by retigabine may reduce the ectopic generation of action potentials in neuropathic pain.
Neuropharmacology 07/2008; 54(8):1271-8. · 4.81 Impact Factor
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ABSTRACT: The intention of this study was to determine the status quo of commonly used pain therapies amongst treating physicians of different specialties and to examine their view on the problem of chronic ischemic pain.
A total of 281 physicians treating patients with chronic ischemic pain were surveyed. The surveyed physicians were mainly specialists in the fields of surgery, pain therapy, and internal medicine.
Mainly a pharmacological therapy (metamizol/paracetamol, weak and strong opioids) was used in the treatment of chronic ischemic pain. We found differences between the specialties, for instance pain specialists used antidepressants and anticonvulsants more often than others. Therapeutic options were also evaluated differently by surgeons, pain therapists, and internal specialists: 57% of the surgeons considered the available symptomatic treatment options as sufficient whereas only 21% of the pain specialists agreed with that opinion.
The differences among the specialties and the fact that the majority of physicians characterized the available symptomatic treatment options as insufficient point towards a need to review the treatment of ischemic pain in an interdisciplinary approach.
Der Schmerz 05/2008; 22(2):164-70. · 0.88 Impact Factor
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ABSTRACT: Application of acetylcholine to peripheral nerve terminals in the skin is a widely used test in studies of human small-fiber functions. However, a detailed pharmacological profile and the subunit composition of nicotinic acetylcholine receptors in human C-fiber axons are not known. In the present study, we recorded acetylcholine-induced changes of the excitability and of the intracellular Ca2+ concentration in C-fiber axons of isolated human nerve segments. In addition, using immunohistochemistry, an antibody of a subtype of nicotinic acetylcholine receptor was tested. Acetylcholine and agonists reduced the current necessary for the generation of action potentials in C fibers by <or=30%. This increase in axonal excitability was accompanied by a rise in the free intracellular Ca2+ concentration. The following rank order of potency for agonists was found: epibatidine > 5-Iodo-A-85380 > 1,1-dimethyl-4-phenylpiperazinium iodide > nicotine > cytisine > acetylcholine; choline had no effect. The epibatidine-induced increase in axonal excitability was blocked by mecamylamine and, less efficiently, by methyllycacontine and dihydro-beta-erythroidine. Many C-fiber axons were labeled by an antibody that recognizes the alpha5 subunit of nicotinic acetylcholine receptors. In summary, electrophysiological and immunohistochemical data indicate the functional expression of nicotinic acetylcholine receptors composed of alpha3, alpha5, and beta4 but not of alpha4/beta2 or of alpha7 subunits in the axonal membrane of unmyelinated human C fibers. In addition, the observations suggest that the axonal membrane of C fibers in isolated segments of human sural nerve can be used as a model for presumed cholinergic chemosensitivity of axonal terminals.
Journal of Neurophysiology 11/2003; 90(5):3295-303. · 3.32 Impact Factor
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ABSTRACT: Analytical figures of merit are often used as criteria to decide whether or not a given instrumental method is suitable for attacking an analytical problem. To date, figures of merit primarily exist for analytical instruments producing data indexed by one variable, i.e., first-order instruments and first-order data. Almost none exist for instruments that generate data indexed by two variables, i.e., second-order instruments and data, and none exist for instruments supplying data indexed by three or more variables, i.e., nth-order instruments and data. This paper develops practical mathematical tools that can be used to create several figures of merit for nth-order instrumentation, namely, selectivity, net analyte signal, and sensitivity. In particular, the paper fully develops a local selectivity measure for second-order instrumentation and tests its performance using simulated second-order data and real second-order data obtained by gas chromatography with Fourier transform infrared detection and liquid chromatography with photodiode array detection. Also included in the paper is a brief discussion on practical uses of nth-order figures of merit.
Analytical Chemistry 05/1996; 68(9):1572-9. · 5.86 Impact Factor
