[Interdisciplinary multimodal pain therapy in postviral syndromes and ME/CFS : Features, pitfalls and model concept]

BACKGROUND

Multimodal pain therapy usually take place in the context of group therapy lasting several weeks and is based on a generally activating approach. Due to the specificity of stress intolerance with postexertional malaise (PEM) in patients with postviral syndromes, physical as well as psychological overload must be urgently avoided in these cases; however, these aspects can only be insufficiently considered in current medical pain therapy concepts.

METHODS

Summary of the current literature and presentation of clinical characteristics as well as presentation of a model project for a multimodal pain therapy in postviral syndromes with PEM.

MODEL CONCEPT

The presented model project describes a day clinic treatment setting for interdisciplinary multimodal pain therapy adapted to the individual resilience with minimization of the risk of strain-induced deterioration of the condition.

The effect of D-penicillamine on plasma amino acids in rheumatoid arthritis

The effect of D-penicillamine (DPA; 150 mg/day) on plasma amino acids administered to female patients suffering from rheumatoid arthritis (RA) was observed daily during the first 9 days of the treatment. A statistically significant influence of the oral DPA administration was detected. In comparison to control, a decrease in 12 out of 18 amino acids was found on day 2. Furthermore, for 6 amino acids an increase and a peak concentration on day 6 or 7 were observed. Surprisingly, similar results were also obtained in rats after oral application of DPA. These findings give further evidence for the multifactorial action of DPA.

Clinical research and the noninstitutional elderly: a model for subject recruitment

Two approaches (normative and symptomatic) are presented for recruiting volunteers for a study of the effects of a vasodilator on the psychophysiologic functioning of elderly patients with mild to moderate cerebroarteriosclerosis. The subjects had to be at least 60 years old, in good physical and emotional health, of at least average intelligence, manifesting cognitive impairment by at least one of several test measures, maintaining themselves in the community, and active in a senior citizens program. Results of both approaches were compared for rates of volunteer response, study eligibility, and admission to the study. The normative approach emphasized data on the normal cognitive changes associated with the aging process. The symptomatic approach focused on the early diagnosis and treatment of an existing cognitive impairment. A combined total of 1,030 potential volunteers, nearly equally divided according to the two techmiques, were addressed in group meetings. With the normative approach, 33 percent volunteered; of this group, 27 percent were found eligible for the study, and of these, 10 percent entered the study. With the symptomatic approach, 36 percent volunteered; of this group, 54 percent were found eligible for the study, and of these, 51 percent entered the study. Thus the symptomatic approach was five times more effective than the normative approach.

[Venous thromboses and pulmonary emboli in autopsy material (author's transl)]

Venous thromboses of the pelvic veins and the veins of the lower limbs were found in 40% of the post mortems carried out on 1350 adults during 1974. The thromboses were bilaterally located in the calf veins in the vast majority of cases. The predominating underlying diseases of patients with thrombosis were malignant neoplasia or cardiovascular diseases. 319 cases (23.5%) showed massive pulmonary embolism. The pulmonary embolism had taken a fulminating fatal course in 7.8% of cases. Thromboses of the lower limb veins seem to have a higher tendency to become mobilized to cause fatal pulmonary embolism than thromboses occurring in other sites. A significantly higher incidence of venous thrombosis, as well as of pulmonary embolism, was found in higher age groups and in female patients; the prognosis is, moreover, grave in these cases. A significant increase in the incidence of venous thromboses and pulmonary embolism-especially those with a rapidly fatal course-has been registered over the past years as compared with previous investigations.