Schmerz最新文献

Background: Interventional procedures are an integral component of multimodal pain management; however, their clinical use and indications remain controversial due to heterogeneous evidence regarding their efficacy. Until now, no systematic data have been available on the prevalence and clinical practice of interventional pain management techniques in Austria.

Objective: The aim of this study was to assess the current clinical practice of interventional pain management in specialized pain centers in Austria and to discuss these findings in the context of the available evidence.

Methods: An anonymous, web-based questionnaire was distributed to specialized pain physicians holding the Austrian diploma in "Specialized Pain Therapy" (Spezielle Schmerztherapie). Participants were surveyed regarding the frequency of use, procedural techniques and indications for interventional pain management procedures. The questionnaire included sympathetic and sensory nerve blocks, neuraxial techniques, intrathecal drug delivery, spinal cord stimulation, auricular vagus nerve stimulation and botulinum toxin injections.

Results: Of the 51 pain centers contacted, 22 participated in the survey (response rate: 43.1%). The most frequently performed procedures were selective nerve root blocks, facet nerve blocks and plexus blocks. Sympathetic blocks and neuromodulation techniques were used less frequently. Most procedures were performed using anatomical landmarks and ultrasound guidance, while imaging techniques such as computed tomography (CT) or fluoroscopy (C-arm guidance) were used selectively. The leading indications were neuropathic pain syndromes and conditions with a neuropathic pain component, particularly radicular back pain, complex regional pain syndrome (CRPS), postherpetic neuralgia and cancer-related pain.

Conclusion: Interventional pain management is widely used in specialized pain centers in Austria, particularly for selected neuropathic pain syndromes. These findings highlight the importance of interventional techniques as part of multimodal pain management while also illustrating the discrepancy between their widespread clinical use and the limited supporting evidence. Structured patient selection and further high-quality scientific evaluation of interventional pain management procedures are warranted.

Traumatic peripheral nerve lesions are defined as loss of nerve function due to the effects of external violence. They are relatively rare but can lead to severe sensorimotor deficits. Further impairments can occur due to soft tissue and bony injuries. Peripheral nerve lesions require a long clinical convalescence period and neurological deficits are often permanent. In recent years, the approach to treating peripheral traumatic nerve lesions has shifted towards early, active treatment upon detection of a structural lesion. This includes surgical reconstructive procedures aimed at restoring the lost functions as effectively as possible. High resolution ultrasound and magnetic resonance neurography have emerged as complimentary tools in the past years. Thus, early detection of structural lesions is possible, which contributes to the strategy of early surgery.

Background: In palliative care, the focus of treatment is on controlling the patient's symptoms. To achieve this, drugs with addictive potential are often used. This can lead to addiction problems, as palliative care patients are surviving longer these days than they did a decade ago.

Aims: This study investigates whether drug misuse and substance abuse are perceived as a problem in specialised outpatient palliative care teams.

Materials and methods: A cross-sectional questionnaire survey was conducted among all German specialised outpatient palliative care teams (n = 366). Data were analysed descriptively.

Results: A total of 129 palliative care teams (35.2%) participated in the survey. Of these, 49.6% stated that an estimated 1-5% of their patients suffer from medication dependency and 65.9% estimate that 1-5% of their patients have drug abuse issues. In all, 69.8% of palliative care teams do not screen their patients for the presence of addiction, while 3.1% do so regularly. If an addiction problem is present, 65.9% of the teams do not take any action.

Conclusion: According to the available data, addiction is not considered a problem in German palliative care. However, it should be noted that almost no palliative care team screens patients for the presence of addiction, although more than half of the teams estimate that at least some patients have an addiction problem. Further research is needed here, as new therapies may help palliative care patients to live longer. It would be important for the development of palliative care and the quality of life of those affected to evaluate how to protect patients from iatrogenically induced substance abuse.

Background: Sex and gender affect pain perception but their role in postoperative pain remains unclear and is not addressed in current guidelines.

Objectives: This scoping review summarizes evidence from the past ten years on sex-related differences in postoperative pain (patient-reported outcome (PRO), opioid consumption) and evaluates their relevance.

Materials and methods: Systematic search in Medline® (March 2015-18 August 2025); 106 studies included.

Primary outcome: acute pain intensity (≤ 3 weeks).

Secondary outcomes: subacute/chronic postsurgical pain and opioid use.

Results: Of the 106 studies included, 44 covered acute pain. In most of them women reported higher pain intensity-particularly after thoracic surgery and orthopedic procedures; several analyses confirmed female sex as an independent predictor for postoperative pain. Studies related to subacute pain (5/106) reported slightly higher pain intensity ratings in women, and the results in chronic pain studies (44/106) were mixed, with more severe pain in women after visceral surgeries. While results for acute opioid consumption (16/106) were heterogeneous, for the long-term postoperative course, studies (9/106) consistently reported a higher persistence of analgesic/opioid use in women.

Conclusions: Sex is a relevant factor regarding pain-related outcome parameters after surgery, and its impact is influenced by the postoperative timeframe and type of surgery. Further studies with standardized, sex-stratified endpoints are required to enable gender-sensitive patient care.

Background: Migraine affects 15% of the global population, with men being 2-3 times less frequently affected than women and are markedly underrepresented in research and clinical care. The condition is frequently underdiagnosed in men.

Objective: The aim of this work is to describe the biological and psychosocial characteristics of migraine in men in order to improve the understanding of sex-related differences and to enhance the diagnostic precision and treatment for men.

Material and methods: This article is a narrative review based on a structured literature search in PubMed using relevant search terms related to migraine and sex differences.

Results: Biologically, men differ from women through hormonal influences on the calcitonin gene-related peptide (CGRP), pituitary adenylate cyclase-activating polypeptide (PACAP) and transient receptor potential (TRP) signaling pathways, which modulate pain processing. Clinically, men exhibit on average shorter attacks, lower intensity, more frequently dull-pressing pain and fewer vegetative accompanying symptoms. This presentation often leads to misdiagnosis. Additionally, role expectations, stigma and lower help-seeking behavior contribute to symptoms being reported later and underestimated more often. Although modern therapies are similarly effective in both sexes, men receive prophylactic treatment less frequently.

Conclusion: The sex-specific biological and psychosocial differences demonstrate that men present with a distinct clinical phenotype of migraine. Greater awareness with respect to these characteristics could enhance the diagnostic accuracy and support more individualized treatment.

Migraine and other headache disorders are highly relevant in the care of transgender patients. Gender-affirming hormone therapies lead to adaptive changes in physiological systems that are typically sexually dimorphic, aligning them with an endocrine milieu corresponding to the affirmed gender. This can substantially influence hormone-dependent components of migraine, such as frequency, intensity and triggering mechanisms. In addition, psychosocial factors play an important role: transgender individuals are often exposed to specific stressors which, within the biopsychosocial model, can directly affect the experience of pain and migraine. The available data are currently very limited and their interpretation is further constrained by small cohorts, predominantly from uncontrolled studies as well as heterogeneous definitions of both headache disorders and the studied populations. Therefore, this article does not claim to be comprehensive but rather provides an overview of the challenges in transgender patients with migraine and other headache disorders.

Background: The scheduled update of the S2k guideline "Diagnosis and treatment of endometriosis", published by the Association of the Scientific Medical Societies in Germany (AWMF; registry number 015/045), was released on April 1, 2025.

Methods: The guideline was developed under the coordination of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG), and the Swiss Society for Gynecology and Obstetrics (SGGG), together with 34 scientific societies (including the German Pain Society), professional organizations and associations, and three patient self-help groups. The systematic literature search followed a predefined algorithm and covered the period from 2019 to 2023. In a structured consensus process, 73 recommendations and 25 statements were formulated in accordance with AWMF regulations.

Results: Compared to the 2020 guideline, the following changes were made regarding pain management: core therapeutic principles were expanded to include chapters on pharmacological symptomatic pain treatment, psychosomatic therapy, complementary therapy, and additional as well as multimodal treatment approaches. A tiered, multimodal treatment strategy for chronic endometriosis-related pain was recommended.

Conclusion: The updated S2k guideline incorporates key concepts of pain medicine, including pain mechanisms (nociceptive, neuropathic, and nociplastic), risk factors for chronification, and biopsychosocial models. Recommendations for pharmacological and non-pharmacological interventions, including tiered multimodal treatment approaches, were developed and agreed upon in an interdisciplinary process based on current evidence and feasibility.

Migraine is a common neurological disorder that affects about 10% of children and adolescents and is associated with reduced school performance and participation in everyday life. The highest incidence of migraine occurs between 10-14 years. With the onset of puberty, girls are increasingly more likely to be affected. Generally, girls in all age groups show a higher prevalence and incidence of migraine, in contrast to tension-type headaches, where gender differences are less pronounced. Girls experience higher levels of migraine-related impairment than boys and are more likely to have comorbid mental health conditions. School-related stress and performance pressure are described primarily by girls as migraine triggers. Gender differences in epidemiology and clinical features have been widely studied in adulthood. Nevertheless, only a few studies deal with gender-specific treatment in childhood and adolescence. In addition to acute pain treatment while avoiding medication overuse, an individualized and multimodal headache therapy is the most important treatment component for recurrent headaches in childhood. Interdisciplinary group therapies enable individualized care for gender-specific circumstances.

Endometriosis is one of the most common causes of chronic pelvic or lower-abdominal pain, yet mechanisms, predictors, and patient-centered treatment pathways remain insufficiently defined. This article summarizes the situation in Germany and presents two complementary research consortia: StEPP-UPP and ENDO-PAIN.StEPP-UPP addresses the clinical heterogeneity of endometriosis pain via a prospective multicenter cohort, standardized patient-reported outcomes, quantitative sensory testing, and multi-omics from blood, stool, and lesions. Explainable artificial intelligence and machine-learning models aim to estimate risk and trajectories of persistent pain, define mechanism-informed subgroups, and support treatment decisions. Preclinical mouse models with non-evoked behavioral metrics plus multiparametric MRI and single-cell analyses provide mechanistic anchoring for clinical signatures.ENDO-PAIN focuses on neuroinflammation and fibrosis as drivers of pain and chronification. Using patient samples, cell cultures, and 3D organoids, it maps immune-stroma interactions, syndecan signaling, and hormone-inflammation axes (for example P4-TGFβ-NFκB-COX-2) to derive biomarker networks and therapeutic targets.Both consortia integrate patient advocacy structurally to ensure patient-relevant endpoints and accessible information. Together they point to three priorities: standardization of data collection and biobanking; stratification along bio-psycho-social profiles and molecular signatures; and interdisciplinary shared decision-making across research, clinics, and people with endometriosis, aiming for mechanistically grounded, data-driven, patient-centered pain medicine.