Biomedical subjects

P Schöps

Publications and source records attributed to P Schöps.

At least 19 recordsLinked to original sources

PubMed2005

[Endogenous cannabinoid system. Effect on neuronal plasticity and pain memory].

AIM: The aim of this study was to evaluate the role of the endogenous cannabinoid system in controlling neuroplasticity. METHODS: The pain threshold for electrical stimuli was determined in transgenic mice lacking the cannabinoid receptor type 1 (CB1(-/-)) and in the corresponding respective wild-type animals. Electrophysiological experiments were performed in prepared brain slices to test the effect of endogenous and exogenous cannabinoids on synaptic transmission and long-term potentiation (LTP) in the amygdala. RESULTS: The pain threshold was nearly identical in both groups for the first pain induction; however, with repeated pain induction it decreased to a significantly greater extent in the CB1(-/-) mice than in the wild-type animals. Synoptic transmission and the inducibility of LTP were not influenced by the acute pharmacological blockade of CB1 receptors, but inhibited by the CB1 agonist WIN55,212-2. CONCLUSION: The endogenous cannabinoid system is involved in the control of neuroplasticity as part of pain processing . Cannabinoids prevent the formation of LTP in the amygdala via activation of CB1 receptors. Synoptic transmission and the inducibility of LTP were not influenced by the acute pharmacological blockade of CB1 receptors, but inhibited by the CB1 agonist Win55,212-2.

Cannabinoids↗

PubMed2004

[Pain treatment facilities in Germany. Ambulatory, day care and inpatient facilities for patients with chronic pain].

Specialised pain treatment is available at inpatient, daycare and outpatient units at hospitals in Germany. A total of 579 hospitals in Germany offer at least one of the three pain treatment options. The main treatment involves outpatient care, but inpatient wards and daycare institutions have become more common. The type and number of pain treatment facilities differ regionally. Five of the 16 counties do not officially offer inpatient care at all, although pain treatment sites have been opened on the initiative of the hospitals themselves. Since specialised pain treatment is insufficiently defined by diagnosis (ICD-10) or procedures (OPS) in the German DRG system, it is not possible to recognise its availability when the facilities are not officially named. Pain treatment should be differentiated dependent on whether patients are treated within a single area of expertise or by specialised multi-professional pain facilities. At hospitals, systematic multimodal pain treatment is possible. Inpatient and daycare pain treatment programs are suitable when outpatient treatment has failed. An overview of the pain therapies offered is a prerequisite for their optimal use, the demonstration of their necessity and for their continued development throughout Germany. This study was planned and supervised by the commission for quality assurance of the German IASP chapter and was sponsored by the German IASP chapter.

Chronic Disease↗

PubMed2003

[Psychometric properties of the pain drawing and the Ransford technique in patients with chronic low back pain].

BACKGROUND: The aim of our study was the analysis of the psychometric properties of the Ransford technique which is a qualitative scoring method of the pain drawing. It has been suggested that this method could be used as a brief screening technique for psychological involvement in pain complaints. METHODS: 109 patients with chronic back pain filled in the pain drawing which was rated according to the technique described by Ransford and colleagues in 1976. As external criterium of validity we chose a differentiated expert rating of psychological interference. RESULTS: The Ransford technique showed moderate to good coefficients of reliability (re-test, inter and intra-rater). On the other hand, the Ransford technique demonstrated very low indices of validity in order to give a prognosis about psychological interference. Sensitivity and specificity of the Ransford technique demonstrated inadequate values, which furthermore were independent from cut-off points. CONCLUSION: The pain drawing and the Ransford technique are not sufficiently sensitive and therefore allow no screening for psychological interference in complaints of back pain.

Adult↗

PubMed2002

[Guidelines in pain treatment--methodical quality of guidelines for treatment of pain patients].

The committee for quality assurance of the German IASP chapter (DGSS) evaluated all relevant guidelines concerning pain treatment. Quality of guidelines was analysed according to the checklist "Methodical quality of guidelines" by Ollenschläger and the user manual released by the German Medical Centre for Quality Assurance. The guideline for the treatment of back pain released by the German Medical Association was examined as well as the one released by the German Association for physical therapy and rehabilitation, the guideline on cervical and lumbal nerve root compression syndrome of the German Association of Neurosurgeons, the guideline for cancer pain of the Drug Committee of the German Medical Association was compared with the one of the German Interdisciplinary Association for Pain Treatment. The guideline for the treatment of chronic headache and facial pain of the Medical Association was evaluated and the guideline for the treatment of trigeminal neuralgia of the German Association of Neurosurgery and Neurology, also the guideline for the treatment of acute postoperative and posttraumatic pain. All guidelines show deficiencies in different aspects and of different severity. At first there are deficiencies in interdisciplinary formulation of the guidelines and identification and interpretation of evidence of multimodal pain treatment options. The most prominent deficiency is the lack of implementation and application trials or impulses by all author associations. This way all expenditure on releasing guidelines is given away without improving quality of pain treatment. The authors' recommendation is to adjust to guidelines and, if they are working or not, tell the authors and improve interdisciplinary in pain treatment guidelines.

Analgesics↗

PubMed2001

Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain.

OBJECTIVES: To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain. DESIGN: Prospective, randomised, placebo controlled trial. SETTING: Three outpatient departments in Germany. PARTICIPANTS: 177 patients aged 18-85 years with chronic neck pain. INTERVENTIONS: Patients were randomly allocated to five treatments over three weeks with acupuncture (56), massage (60), or "sham" laser acupuncture (61). MAIN OUTCOME MEASURES PRIMARY OUTCOME MEASURE: maximum pain related to motion (visual analogue scale) irrespective of direction of movement one week after treatment. SECONDARY OUTCOME MEASURES: range of motion (3D ultrasound real time motion analyser), pain related to movement in six directions (visual analogue scale), pressure pain threshold (pressure algometer), changes of spontaneous pain, motion related pain, global complaints (seven point scale), and quality of life (SF-36). Assessments were performed before, during, and one week and three months after treatment. Patients' beliefs in treatment were assessed. RESULTS: One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage (difference 24.22 (95% confidence interval 16.5 to 31.9), P=0.0052) but not compared with sham laser (17.28 (10.0 to 24.6), P=0.327). Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years (n=75) and in patients with myofascial pain syndrome (n=129). The acupuncture group had the best results in most secondary outcome measures. There were no differences in patients' beliefs in treatment. CONCLUSIONS: Acupuncture is an effective short term treatment for patients with chronic neck pain, but there is only limited evidence for long term effects after five treatments.

Acupuncture Analgesia↗

PubMed2000

[Diagnostic criteria and new classification of the cervical spine syndrome].

OBJECTIVES: Pain and functional disorders of the neck are widely diagnosed as "cervical spine syndrome". As this diagnosis is not able to sufficiently specify the different symptoms, a new classification with five pain syndromes, created empirically, was developed. The aim of this study is to evaluate the predictive values of the diagnostic criteria respectively clinical findings of patients diagnosed with cervical spine syndrome. METHODS: Within the two year time frame of the study all patients diagnosed with "cervical spine syndrome", which presented themselves at the clinic, were included. The statistic analysis was performed in multiple steps: univariate analyses, bivariate variable screening and the use of the logistic regression model. RESULTS: Within two years 653 patients previously diagnosed as suffering from cervical spine syndrome presented at the clinic; 332 of them were included in the study. According to the diagnostic criteria they were attached to one of the five pain syndromes. The statistical analysis showed in 17 of 35 evaluated diagnostic criteria a significant association to one of the five subgroups of the cervical spine syndrome. CONCLUSION: The statistical analyses revealed significant associations between diagnostic criteria which were assessed by clinical examination and the five subgroups of the cervical spine syndrome. The identified predictors represent the typical syndrome-associated diagnostic criteria of a certain syndrome-subgroup.

English Abstract↗

PubMed2000

[Classification of chronic pain. Quantification and grading with the Mainz Pain Staging System].

INTRODUCTION: Chronic pain is an individually variable experience, incorporating physical, psychological and social dimensions. Chronic pain occurs in a broad spectrum of severity; therefore, a grading procedure is of crucial importance in clinical research and in epidemiologic studies. The Mainz Pain Staging System is an interview-administered, multi-dimensional measure of chronic pain severity. The system suggests grading chronic pain in terms of 4 axes: time (persistence), spreading of pain site, medication use, and health care utilization. The whole scale consist of 10 items. The resulting score is used to classify the pain problem in three stages (I, II, III). Analysing the broader validity and parametric properties of the staging system is the purpose of the present study. METHODS: The staging system and psychosocial data were administered to 542 consecutive patients of different diagnoses who attended one of six pain clinics in the year 1995/96. In a time period of 3 months since first contact, treatment procedures were registered. Three months after first contact patients rated the effectiveness of treatment concerning reduction of pain intensity. RESULTS: According to the criteria of the staging system 25% of the sample belonged to each stage I and stage III, whereas 50% were classified to stage II. As a measure of validity, chronic pain status demonstrated significant correlation with psychological impairment, disability and time off work, whereas there was no correlation to pain intensity and persistence of pain. Surprisingly we found no difference in amount and quality of treatment between patients who were graded as severe pain patients (stage III) and the other stages. Furthermore, effectiveness of treatment also did not differ between the three stages. We made several proposals for optimizing the staging system. CONCLUSION: Given the high prevalence of recurrent and chronic pain as well as the broadness of severity, an important issue on further research is identification of factors which influence the chronification process. For this purpose improved measures of graded classification of pain status are needed.

English Abstract↗

PubMed2000

Continuous axillary brachial plexus analgesia with low dose morphine in patients with complex regional pain syndromes.

In this prospective pilot study, nine patients suffering from complex regional pain syndrome of the arm were treated with morphine 0.16 mg h-1 (3.84 mg day-1) applied continuously through an axillary brachial plexus catheter. In all of them an oral analgesic medication including the less potent opioid tramadol had not provided sufficient pain relief. During regional treatment, patients were kept in hospital and physiotherapy was carried out frequently in order to improve strength and function of the affected arm. Pain at rest and during movement as well as grip strength were assessed at first visit, during morphine infusion and at a long-term follow-up visit. All assessments improved significantly during plexus analgesia. There were no major opioid related side-effects. The results from this pilot study indicate that continuous axillary brachial plexus analgesia with low dose morphine might be beneficial in patients suffering from complex regional pain syndrome of the arm.

Adult↗

PubMed1999

[Reliability of functional x-ray analysis of cervical vertebrae flexion and extension].

Functional radiographic analysis of the cervical spine in flexion and extension position is increasingly used as screening method for the diagnosis of segmental functional disorders. The objective of this study was to prove Penning's evaluation method for the metrical recording of segmental angles in the sagittal plane for selectivity, reliability and usability. Passive functional radiographs of the cervical spine in flexion and extension were taken of 20 patients with painful limitation of mobility of the cervical spine and 20 subjects, similar in sex and age, without complaints. The radiographs were duplicated. Five physicians measured the angles of segmental mobility in a blind study. Statistical analysis was conducted using the t-test and calculating the correlation coefficient "r". The results of the study prove that the evaluation method by Penning shows a usable and, for segments C3/C4 to C6/C7, significant selectivity. The selectivity of p < or = 0.05 and p < or = 0.01 is sufficient to distinguish patients from healthy subjects. The correlation between the five reviewers showed good to very good results (0.6 < r < or = 0.8; r > 0.8). The measured values, however, have to be considered, in connection with the appropriate clinical symptoms, as still "normal" or "functionally disordered" in the context of segmental hypo-resp. hypermobility.

Adult↗

PubMed1993

[Clinical significance of cervico-ocular reactions].

Cervically induced eye movements consist of a nystagmus and a deviation of the mean eye position (shift). They show in relation to different neck torsion velocities maximum reactions at slow velocities. The clinical significance of these cervico-ocular reactions is discussed controversially. Therefore we investigated 40 healthy subjects without any neurootological findings, who, in addition, underwent a manual examination. The neck torsion test was performed automatically with quantifiable stimulus parameters and a complete head fixation by means of individual dental casts. It could be shown that at a constant chair velocity of 5 degrees/s every healthy subject exhibits cervical nystagmus and/or shift deviations. In comparison a group of 30 patients with an upper cervical spine syndrome also showed similar cervico-ocular reactions without significant difference. It can be concluded that a muscle hypertonus in the deep neck region does not lead to pathological, cervically induced eye movements and that the cervical nystagmus itself is not a pathognomonic sign for cervical, proprioceptive vertigo.

Adult↗

PubMed1989

[The diuretic effect of a bath. Study in healthy pregnant females and patients with edema and gestosis].

The effect of a 40 minute thermoneutral bath on diuretic function and blood volume in a total of 27 pregnant women (13 healthy and 14 pregnant women with edema rsep. EPH-gestosis) was investigated. In both groups water immersion led to a significant increase of urine flow, natriuresis, kaliuresis, osmotic and free water clearance. Plasma volume increased about 8-9%. The patients with gestosis showed a higher creatinine clearance. The same group also showed a higher osmotic clearance and relatively more sodium excretion. Regarding the flushing effect of bath, two mechanism of water immersion that originated in hydrostatic pressure have to be discussed-activation of renal functions and mobilisation of interstitial fluid.

Baths↗

PubMed1988

Pharmacokinetics of methotrexate during regional hyperthermia in a pig model.

In the pig model, regional hyperthermia in the gluteus was combined with the infusion of 150 mg MTX over a period of 100-120 min. The pharmacokinetic data reveal that this approach is capable of simulating the situation that is necessary and achievable in medium-dose MTX therapy of human tumours. Under MTX infusion, serum levels in the region of 10(-5) M are attained. As an expression of a renal and hepatic MTX excretion, high levels of MTX are found both in the urine and in the bile. Especially high concentrations of MTX are found in the liver and kidney tissue. In the normothermic and hyperthermic muscle, very low MTX levels are found. The pharmacokinetic data obtained show that the selected model is suitable for the future investigation of the effect of regional hyperthermia and MTX on transplanted tumours.

Animals↗

PubMed1987

An investigation of the microcirculation of the human tympanic membrane with laser-Doppler flowmetry.

The present investigation was performed to evaluate the use of laser-Doppler flowmetry as a means for measuring the blood flow of the microcirculation of the human tympanic membrane. The blood cell flux in the microvascular bed of the normal tympanic membrane was measured in healthy subjects. The laser-Doppler output signals continuously recorded showed a steady value ranging from 70 to about 120 V, as well as spontaneous oscillations (or rhythmical active vasomotion). Our findings show that the laser-Doppler instrument tested seems to be useful for evaluating blood flow changes in the microcirculation of the human tympanic membrane.

Adult↗

PubMed1985

The effects of external CO2 application on human skin microcirculation investigated by laser Doppler flowmetry.

The effects of an aqueous solution of CO2 applied to a small skin site were investigated by means of a laser Doppler flowmeter. The circulatory response to CO2 was an increased blood flow, reaching a maximum level within approximately 2-3 minutes. In addition there was a marked stimulation of rhythmical vasomotion, especially an increase in amplitudes. The effects, strongly dependent on dose and temperature, ceased rapidly when the CO2 sample was withdrawn.

Carbon Dioxide↗

PubMedDate not supplied

[Reliability of manual medical examination techniques of the cervical spine. Study of quality assurance in manual diagnosis].

OBJECTIVE: Chiropractic techniques are of particular importance for the examination of the cervical spine. The aim of this study was to assess interexaminer reliability of examination techniques of the cervical spine in subjects with and without musculoskeletal distortions of the neck. The interrater method was used with five independent examiners. METHOD: Twenty patients suffering from neck diseases and 20 asymptomatic subjects of similar age and gender were randomized and assessed by five examiners blind to patient histories. Statistical analysis was carried out using multiple logistic regression and the calculation of kappa. RESULTS: Compared to asymptomatic subjects, patients experienced pain significantly often when pressure was applied to the cervical zygapophysial joints and the superficial neck muscles (p < or = 0.05 and p < or = 0.01). In addition, segmental function tests induced kinesialgia significantly more often in patients than in asymptomatic subjects (p < or = 0.05 and p < or = 0.01). A significant relationship was not found between the patient's health status and the findings from muscle palpation and functional examination of the motion segments. The assessment of agreement within examiners beyond chance had to be calculated, aside from for few exceptions, little to moderate (0.2 < kappa < or = 0.6). CONCLUSIONS: Chiropractic techniques are an essential part of every examination of the cervical spine. The clinical impact has not been scientifically established until up to now. Based on our findings and literature, we conclude that interexaminer reliability of manual diagnosis in the examination of the cervical spine should be improved by standardizing the examination process and setting guidelines for documentation and evaluation criteria. Controlled and frequently repeated training sessions also contribute to the reproducibility of findings from manual examinations.

Adult↗

PubMedDate not supplied

[Low back pain: from symptom to chronic disease].

In several prospective studies it has been demonstrated that psychological factors are better predictors of low back pain than biographical or medical factors. The most elaborate model for the development of chronic low back pain is the model of fear avoidance. The essential feature of this model is that exaggerated negative orientations towards pain ("pain catastrophizing") lead to fear of movements and the belief that movements will lead to more pain. The result is the perpetuation of avoidance behavior. This leads to inactivity, reduced mobility, increased disability, and increased anger, demoralization, anxiety, and depression. From fear avoidance models several principles for the therapeutic management of pain can be derived. Therapists have to be aware of the powerful effects of anticipating processes which can give rise to fear of pain, amplifying the intensity of pain, and consequently result in avoidance behavior. On the other hand, reduction of uncertainty via adequate information about the non-serious nature of back pain disorders may lead to an adequate confrontative pain behavior, less emotional arousal and more useful coping mechanisms. In particular, the uncritical use of widespread back schools has to be looked upon carefully for pronouncing avoidance learning. For chronic pain, therapy must include mechanisms from the treatment of phobias in which pain behavior is looked upon as the result of a phobic process.

Avoidance Learning↗

PubMedDate not supplied

Intravertebral vacuum phenomenon following fractures: CT study on frequency and etiology.

PURPOSE: The purpose of this work was to determine the frequency and etiology of the intravertebral vacuum phenomenon (IVP). METHOD: CT examinations of 96 vertebral fractures were evaluated for IVP. Bone mineral density (BMD) was determined in nonfractured vertebrae. For calibration purposes, densities of a standard phantom measured in 30 patients who underwent quantitative CT examinations in the same time period were used and precision was calculated. RESULTS: Eleven of 96 fractures (11.5%) showed IVP. IVP was present in 4 of 20 fractures at T12 (20%), in 4 of 23 at L1 (17.4%), and 1 IVP was found at L2-4 each. Mean +/- SD age of patients with IVP was 68.3 +/- 10.5 years and without 47.8 +/- 19.4 years (p < 0.001). Mean +/- SD density of nonaffected vertebra was 45.9 +/- 17.0 mg of hydroxyapatite/ml for patients with IVP and 139.5 +/- 62.6 mg/ml for those without IVP (p < 0.0005). An average precision of 1.2% was calculated for the density measurements over the investigated time. CONCLUSION: Following vertebral fractures, IVP on CT scans is more common than presumed and increases with age. There exists a significant inverse correlation between the BMD and the frequency of IVP.

Age Factors↗

PubMedDate not supplied

[Hemorheologic changes in chronic polyarthritis].

The haemorheological status of plasma-(P eta) and blood-viscosity (B eta), erythrocyte aggregation (EA) and erythrocyte filterability (EF), blood sedimentation rate (BSG), haematocrit (HCT), plasma fibrinogen and alpha-2-macroglobulin was investigated on 46 patients suffering from chronic polyarthritis (c.P.). The results were compared with those from a control group of 20 healthy subjects with a similar distribution of age and sex. All the haemorheological data from the c.P. patients showed a significantly decreased blood fluidity (p less than or equal to 0.001 or p less than or equal to 0.01). These differences were highly significant for the female patients (n = 29), but for the men (n = 17) only at slight shift was seen. The comparison of clinically acute and non-acute disease in the patients showed a significant worsening of P eta, B eta and EF during the acute state, while the EA remained unaffected. The limited blood fluidity is seen as a result of the basic illness. At present, the pathophysiological meaning of these findings is still hypothetical: further investigations are required.

Arthritis, Rheumatoid↗