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Biomedical subjects

D Soyka

Publications and source records attributed to D Soyka.

At least 19 recordsLinked to original sources
PubMed1999

The efficacy of a risk factor-based cognitive behavioral intervention and electromyographic biofeedback in patients with acute sciatic pain. An attempt to prevent chronicity.

STUDY DESIGN: An investigation of the efficacy of an individually scheduled, risk factor-based cognitive behavioral therapy and a standardized electromyographic biofeedback intervention in the prevention of chronicity in patients with acute sciatica and psychosocial risk factors for chronicity. OBJECTIVES: To investigate the possibility of enhancing pain relief and preventing chronicity in patients with acute sciatica, based on a screening for psychosocial high-risk factors of chronification. SUMMARY OF BACKGROUND DATA: Psychological interventions were evaluated mainly in patients with chronic low back pain. Numerous randomized trials have demonstrated their efficacy, whereas the amount of pain relief was found to be marginal. METHODS: Subjective and behavioral outcome parameters were compared with the respective parameters in age-, gender-, and diagnosis-matched high- and low-risk patients. No additional behavioral treatment for in-patient medical therapy was offered to the patients. Outcome of these patients also was compared with that of a group of refusers of behavioral therapy. Psychological, functional, and behavioral variables were measured before and after treatment and at 3-, 6-, 12- and 18-month follow-up visits. Changes over time, group differences, and possible group x time interactions were analyzed by analysis of variance and nonparameteric comparisons. RESULTS: Data analysis showed a statistically and clinically significant, beneficial effect of both behavioral interventions. However, risk factor-based cognitive behavioral therapy was superior to electromyographic biofeedback intervention with respect to pain relief and application for early retirement. The cognitive behavioral therapy showed a similar good outcome (e.g., 90% showed a clinical significant pain reduction) as the low-risk patients (83% pain reduction). High risk patients and refusers of therapy showed a poor outcome in pain (33% and 20% pain reduction, respectively), disability, and work performance. CONCLUSIONS: Individually scheduled, risk factor-based cognitive behavior therapy could be a beneficial treatment modality, which can be offered, in addition to a medical treatment, to patients with acute sciatica and psychosocial high risk factors for chronicity. It may be an effective way to prevent chronification in these patients.

Acute Disease↗
PubMed1996

[Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type].

The effect of a locally applied peppermint oil preparation on tension-type headache was examined in the design of a randomized, placebo-controlled double-blind crossover study for the first time. The preparation was tested against both the reference substance acetaminophen and to the corresponding placebo. The liquid test preparation contained 10 g of peppermint oil and ethanol (90%) ad 100 (test preparation LI 170, Lichtwer Pharma, Berlin); the placebo was a 90% ethanol solution to which traces of peppermint oil were added for blinding purposes. The reference preparation contained 500 mg acetaminophen; the placebo tablet was identical to the verum in size and appearance. The study included the analysis of 164 headache attacks of 41 patients of both sexes ranging between 18 and 65 years of age, suffering from tension-type headache in accordance with the IHS classification. Four headache episodes per patient were treated in a double-blind, randomized crossover design. Each headache attack was treated by the application of 2 capsules of the oral medication (1,000 mg of acetaminophen or placebo) and the cutaneous application of the oil preparation (peppermint oil or placebo solution). The oil was spread largely across forehead and temples which was repeated after 15 and 30 minutes. Using a headache diary, the headache parameters were assessed after 15, 30, 45 and 60 minutes. Compared to the application of placebo, a 10% peppermint oil in ethanol solution significantly reduced the clinical headache intensity already after 15 minutes (p < 0.01). This significant clinical reduction of the pain intensity continued over the one hour observation period. Acetaminophen, too, proved to be efficient compared to placebo (p < 0.01). There was no significant difference between the efficacy of 1,000 mg of acetaminophen and 10% peppermint oil in ethanol solution. Simultaneous application of 1,000 mg of acetaminophen and 10% peppermint oil in ethanol solution leads to an additive effect which remains below the significance threshold, however. The patients reported no adverse events. This controlled study showed for the first time that a 10% peppermint oil in ethanol solution efficiently alleviates tension-type headache. Peppermint oil thus proves to be a well-tolerated and cost-effective alternative to usual therapies.

Acetaminophen↗
PubMed1996

Magnesium in the prophylaxis of migraine--a double-blind placebo-controlled study.

The migraine prophylactic effect of 10 mmol magnesium twice-daily has been evaluated in a multicentre, prospective, randomized, double-blind, placebo-controlled study. Patients with two to six migraine attacks per month without aura, and history of migraine of at least 2 years, were included. A 4-week baseline period without medication was followed by 12 weeks of treatment with magnesium or placebo. The primary efficacy end-point was a reduction of at least 50% in intensity or duration of migraine attacks in hours at the end of the 12 weeks of treatment compared to baseline. With a calculated total sample size of 150 patients, an interim analysis was planned after completing treatment of at least 60 patients, which in fact was performed with 69 patients (64F, 5M), aged 18-64 years. Of these, 35 had received magnesium and 34 placebo. The number of responders was 10 in each group (28.6% under magnesium and 29.4% under placebo). As determined in the study protocol, this was a major reason to discontinue the trial. With regard to the number of migraine days or migraine attacks there was no benefit with magnesium compared to placebo. There were no centre-specific differences, and the final assessments of treatment efficacy by the doctor and patient were largely equivocal. With respect to tolerability and safety, 45.7% of patients in the magnesium group reported primarily mild adverse events like soft stool and diarrhoea in contrast to 23.5% in the placebo group.

Adolescent↗
PubMed1994

Risk factors of chronicity in lumbar disc patients. A prospective investigation of biologic, psychologic, and social predictors of therapy outcome.

STUDY DESIGN: The current prospective longitudinal study examined the predictive value of psychological, somatic and social variables for the prediction of the short- and long-term follow-up in 111 consecutively selected patients with acute radicular pain and a lumbar disc prolapse or protrusion. OBJECTIVES: The criteria for the therapy outcome were the intensity of persistent pain at the time of the discharge from the hospital and 6 months later and the application for early retirement at the 6 month follow-up. METHODS: As for the psychological predictors, we examined depression (Beck Depression Inventory BDI), daily hassles (Kiel Interview of the Subjective Situation KISS), pain coping strategies (Kiel Pain Inventory KSI), and Health locus of control (GKU). As somatic predictors, we assessed the duration of pain before treatment, previous operations, paresis, disc displacement, scoliosis, adipositas, treatment, and age. As social predictors, we assessed the social status, occupational characteristics, and the duration of inability to work. RESULTS: The results indicated that persistent pain was best predicted by a combination of somatic (degree of disc displacement), psychological (depression and the pain coping strategies avoidance behavior, endurance strategies, nonverbal pain behavior and search for social support), and social parameters (social status and sitting position) with a correct prediction in 86%. The application for early retirement at the 6 month follow-up was best predicted by depression and stress at work. CONCLUSIONS: The results lead to several hypotheses about biopsychosocial interrelations within the chronification of radicular pain and provide the clinician with a short screening instrument for early diagnosis of chronification.

Adolescent↗
PubMed1994

Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters.

The effects of peppermint oil and eucalyptus oil preparations on neurophysiological, psychological and experimental algesimetric parameters were investigated in 32 healthy subjects in a double-blind, placebo-controlled, randomized cross-over design. Four different test preparations were applied to large areas of the forehead and temples using a small sponge and their effect was evaluated by comparing baseline and treatment measure. The combination of peppermint oil, eucalyptus oil and ethanol increased cognitive performance and had a muscle-relaxing and mentally relaxing effect, but had little influence on pain sensitivity. A significant analgesic effect with a reduction in sensitivity to headache was produced by a combination of peppermint oil and ethanol. The essential plant oil preparations often used in empiric medicine can thus be shown by laboratory tests to exert significant effects on mechanisms associated with the pathophysiology of headache.

Administration, Topical↗
PubMed1994

The epidemiology of headache in Germany: a nationwide survey of a representative sample on the basis of the headache classification of the International Headache Society.

This study presents the first account of the prevalence of headache syndromes, defined according to the International Headache Society criteria, in a large representative sample of the German population; 5000 persons representative of the total population were selected from 30,000 households. Subjects were requested to answer a questionnaire about headache occurrence during their lifetime. The completion rate was 81.2%. Seventy-one point four percent (n = 2902) reported a history of headache. Twenty-seven point five percent fulfilled the criteria for migraine. Thirty-eight point three percent (n = 1557) met the criteria for tension-type headache and 5.6% (n = 229) did not fulfil criteria for either migraine or tension-type headache. Significant correlations were found between the prevalence of the different headache syndromes and sociodemographic variables such as sex, age and place of residence. The prevalence of headache did not exhibit any significant differences between the various länder (states or regions) of Germany. When extrapolated to the total population these results reveal that 54 million people in Germany suffer from headache at least occasionally or persistently. These findings suggest that the magnitude of the neurological disorders, migraine and tension-type headache, is seriously underestimated and thus constitutes a major contemporary health problem.

Age Distribution↗
PubMed1994

Exteroceptive suppression of temporalis muscle activity during migraine attack and migraine interval before and after treatment with sumatriptan.

We compared the early (ES1) and late (ES2) exteroceptive suppression (ES) periods of temporalis muscle activity in 18 migraine patients during both the migraine interval and migraine attack and investigated the effect of sumatriptan and placebo on ES parameters. The measurements were performed in a balanced sequence at four different times on each patient, twice during the migraine interval and once in each of two migraine attacks. First ES1 and ES2 were measured (stimulus intensity 20 mA, stimulus duration 0.2 ms, stimulation frequency 2 Hz, averaging of 10 responses), then the medication was given on a double-blind basis with an autoinjector using either 6 mg sumatriptan or a placebo solution. Thirty minutes after application the measurements were repeated. No significant differences were found in early and late exteroceptive suppression latencies and durations between baseline measurements. Treatment did not affect the latencies of ES1 and ES2. While sumatriptan caused a significant increase in ES1 duration (p < or = 0.05) both during the migraine interval and during the migraine attack, placebo showed no significant effect on ES1 duration. Treatment with sumatriptan during the migraine attack was accompanied by a significant increase in the duration of ES2 (p < or = 0.05), but no significant changes in the durations of the late suppression periods were observed under any other conditions. The results do not support the assumption that under the experimental conditions chosen migraine attacks are accompanied by a paroxysmal change in the brain-stem mechanisms involved in the modulation of the ES parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Amitriptyline in therapy of chronic tension headache].

In a double-blind, placebo-controlled trial, the effect of 75 mg of a slow-release formulation of amitriptyline on the clinical severity of chronic tension-type headache and on headache-associated neurophysiological parameters (EMG activity, exteroceptive suppression of temporal muscle activity, contingent negative variation (CNV) and experimental pain sensitivity) was investigated. All of the patients treated had a history of headaches of many years standing, and numerous failed attempts at treatment. In the amitriptyline group, a significant reduction in daily headache duration was already found in the third week of treatment, while in the placebo group no significant changes in headache duration were to be seen. In week 6 the amitriptyline group had a significantly shorter daily duration of headache than the placebo group. Treatment did not result in any significant effects on EMG recording of pericranial muscle activity either during relaxation or contraction, on exteroceptive suppression of the temporal muscle and on CNV. The sensitivity to suprathreshold experimental pain, however, was significantly reduced. The data show a statistically relevant reduction of daily headache duration in chronic tension-type headache. However, they also show that amitriptyline can only partly alleviate chronic headaches but cannot cure them.

Adolescent↗
PubMed1994

[Stiff-man syndrome. Report of 4 cases].

Four patients are presented who exhibited progressive muscular rigidity in both legs, the thoracolumbar, paraspinal and the abdominal muscles. In only one patient, there was an initial involvement of the shoulder girdle muscles. Electromyography in all four patients at rest recorded continuous electric activity resembling an interference pattern. Following sudden exteroceptive stimuli the activity increased in amplitude and density this corresponded clinically to painful spasms. All patients had oligoclonal banding in CSF. In the serum and CSF of three patients IgG subtype autoantibodies were detected. These have been found to be directed against GABAergic nerve terminals in the rat and human cerebellum and, more specifically, to glutamic acid decarboxylase. All patients improved on clonazepam. Trials of intermittent high-dose methylprednisolone administration gave relief from rigidity in one patient and permitted reduction of clonazepam in another. Intravenous immunoglobulins however had no effect in one patient.

Adult↗
PubMed1993

Hypnotic hypo- and hyperalgesia: divergent effects on pain ratings and pain-related cerebral potentials.

Pain ratings and pain-related cerebral potentials in response to noxious stimuli were investigated under hypnotic hypo- or hyperalgesia. Out of a sample of 50 subjects the 10 most highly hypnotizable were selected using the Stanford Hypnotic Susceptibility Scale. Phasic pain was induced by brief electrical stimuli intracutaneously applied to the subject's left middle finger. The subjects took part in three experimental sessions. The first session was without hypnosis for familiarization with the experimental surroundings. In the two other sessions, the subjects were hypnotized and given a suggestion of analgesia or hyperalgesia with respect to pain sensation in the left hand. The sequence of hypnosis was matched within and between sessions. Pain ratings and late cerebral somatosensory evoked potentials (SEP) were used to quantify pain reactions. In addition, auditory evoked potentials (AEP) and spontaneous EEG were evaluated to differentiate between pain-specific and unspecific effects of hypnosis. Only the subjects' verbal reports of pain were drastically influenced by hypnosis: suggestion of analgesia diminished the mean pain ratings, suggestion of hyperalgesia enhanced them (P < 0.001). In contrast, the amplitudes of the late somatosensory potentials evoked by the pain-inducing stimuli were not modified in either of the suggestive states. Furthermore, no effects of hypnosis were found on AEPs and on the power spectra of the spontaneous EEG. The results are discussed on the basis of a dissociation of sensory and affective components of pain under hypnosis.

Adult↗
PubMed1992

[Migraine and tension headache. New procedures for objective differentiation].

AIMS: Presentation of a new questionnaire for headache analysis that supplements a computer-aided scheme for the diagnosis of headaches. MAJOR POINTS: The classification scheme of the International Headache Society (IHS) represents an instrument for the classification and identification of headaches that makes use of phenomenological criteria. On this basis, a computer program was developed that permits clearly differentiated analysis of various common types of headache. Both primary forms of headaches and clinically relevant secondary forms are taken into account. Since many--although not all--doctor's offices are equipped with personal computers, a questionnaire has now been developed with the aid of which the two major primary forms of headache, migraine and tension headache, can be distinguished. On average, the patient takes only five minutes to complete the questionnaire. Evaluation is performed simply, with the aid of an evaluation sheet. Types of headache other than those described cannot be excluded on the basis of the questionnaire.

Diagnosis, Differential↗
PubMed1992

Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache.

We investigated whether experimentally determined, suprathreshold pain sensitivity of pericranial musculature in patients with tension-type headache differs from that of migraine patients or from that of healthy subjects. Furthermore, we looked to see whether differences could be found in the effects of experimental pain induction on EMG activity of pericranial musculature and whether subgroups could be discovered with higher and lower pericranial pain sensitivity within the three diagnostic groups in terms of neurophysiological, psychological and clinical variables. In 20 patients with tension-type headache, 23 patients with migraine without aura, and 29 healthy individuals experimental pain was induced in the temporal muscle by mechanical pressure; pain sensitivity in the entire metrically subdivided suprathreshold pain sensitivity range was measured. Surface EMG activity of pericranial muscles was determined before, during and after experimental pain induction. In addition, headache characteristics as well as personality and mood states were determined and recorded in a standardized fashion. There were no significant differences in pain sensitivity of pericranial musculature between the three groups. Patients with tension-type headache showed significantly higher EMG scores during suprathreshold pain stimulation than did migraine patients. EMG scores of healthy subjects fell between these two groups. With respect to pericranial tenderness significant differences in clinical, neurophysiological and psychological variables were found only between subgroups within the group of patients with tension-type headache. The results indicate that significant differences in the examined groups are found not in pain perception but in the processing or reaction to experimental headache stimuli. In patients with tension-type headache subgroups evolve based on pericranial pain sensitivity with quantitatively and/or qualitatively impaired reactions; for this reason diagnostic grouping according to the IHS classification seems to be pathophysiologically relevant. The intraindividual phasic comparison of pain reactions appears to be more important than the absolute interindividual tonic comparison.

Adult↗
PubMed1992

[Recommendation for an expanded classification with operational diagnostic criteria for craniocerebral trauma].

Neither nationally nor internationally is there today agreement on a classification of head injuries. The traditional system using the terms commotio/concussion, contusion and compression, as well as more functionally oriented classifications are in-adequate for present-day purposes. Furthermore, there is no conformity in evaluating the severity and duration of the posttraumatic disturbances of consciousness. None of the classifications in use today includes information on important details such as the type of head injury (closed or open), possible complications or the findings of modern neurophysiological investigation and neuroimaging procedures. The requirements which a modern classification system must meet are specified and a classification of head injuries with operational diagnostic criteria is proposed, which is intended to satisfy both clinical and scientific requirements.

Brain Concussion↗