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Es gibt zahlreiche neurobiologische, klinische und epidemiologische Belege daf��r, dass die Ph��nomene der Angst- und der Schmerzempfindung eng miteinander interagieren. Beide Systeme gehen mit Stressaktivierungsvorg��ngen einher, und beide Systeme werden ihrerseits durch Langzeitstress moduliert. Die Koppelung von Schmerz, Angst und Stress erkl��rt auch die hohe Komorbidit��t von Schmerz- und Angsterkrankungen. Diese Zusammenh��nge sollen auffordern, die individuelle Patientenrealit��t in ihrer integrativen Gesamtheit zu erfassen, in der sich nozizeptive, affektive und vegetative Symptome oftmals bedingen und verst��rken., There is considerable neurobiological, clinical and epidemiological evidence that the systemic phenomena of anxiety and pain closely interact. Both perceptions trigger stress activation processes and are in turn modulated by long-term stress. This overview illustrates the coupling of pain, anxiety and stress with some clinical examples. The relations shown here should help us to gain a holistic view of the individual patient and his/her psychosocial reality, in which nociceptive, affective and vegetative symptoms are often interdependent and mutually reinforcing each other.

Julian A Stewart,1 Simone Mailler-Burch,1 Darius Müller,1 Martina Studer,1 Roland von Känel,2,3Martin grosse Holtforth,1,4Kyrill Schwegler,1 Niklaus Egloff1,21Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland; 2Department of Clinical Research, Bern University Hospital, University of Bern, Bern, Switzerland; 3Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 4Department of Psychology, University of Bern, Bern, SwitzerlandPurpose: Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The “ABC indicators” presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress.Patients and methods: We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated.Results: The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17–10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30–21.28).Conclusion: The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria.Keywords: chronic pain, diagnostic criteria, widespread pain, hyperalgesia, psychological distress, Complex Generalized Pain Syndrome (CGPS)

Long-term consequences of aversive childhood experiences: effects on the incidence of psychiatric illnesses Abstract. Early childhood stress experiences through physical, psychological and sexual abuse as well as emotional or physical neglect often lead to permanent changes in the psychological well-being. Clinically, this is shown among other things in an increased incidence of various psychiatric disorders. This narrative survey aims to summarize the current status of existing studies on early childhood stress experiences and related psychiatric consequences. Scientific publications from the online libraries PubMed, PsycINFO and GoogleScholar served as the database. The search was conducted under the keywords Adversive Childhood Events (ACE), Adverse Childhood, Childhood Trauma, Psychiatric Disorders, Health Consequences as well as their German translations. The search resulted in 46 studies to be considered.

Consequences of aversive childhood experiences: effects on the neuroendocrine system Abstract. Childhood experiences of stress due to neglect, physical, psychological or sexual abuse lead in many cases to permanent changes in the stress-regulating neuroendocrine processes. Epidemiological studies already showed 20 years ago that the extent of childhood stressors correlates with the occurrence of various somatic, functional and psychological diseases in adulthood and that cumulative stressors are also reflected in a significantly reduced average life expectancy. The altered stress-related endocrine system is of major importance with regard to the pathogenesis of the secondary somatic, functional and psychological disorders mentioned above.

Long-term consequences of aversive childhood experiences: effects on cerebral structures Abstract. Early childhood stress experiences due to neglect, and physical, psychological or sexual abuse can lead to permanent changes in central nervous structures. The central nervous system generally shows a very high plasticity in early childhood. Objectively, these influences are reflected in functional and structural-morphological changes in certain brain areas. Subjectively, they are manifested through changes in cognitive, emotional, perceptive and social experiencing. This review aims to summarize the current status of the limited number of studies with human subjects on the consequences of early childhood stress experiences with focus on the central nervous system.

Rafael JA Cámara,1 Raschid K Gharbo,2 Niklaus Egloff3 1 medscoops ® – Health Sciences, Mainz, Germany; 2Zürcher RehaZentrum, Klinik Davos, Davos-Clavadel, Switzerland; 3Department of Neurology, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, SwitzerlandCorrespondence: Raschid K Gharbo Rosenhügelweg 7, Davos-Platz 7270, SwitzerlandTel +41 79 245 67 47Email r.gharbo@bluewin.chPurpose: Prior findings suggest that women and elderly persons are more sensitive to pressure than men and younger persons; however, the magnitudes of these differences are substantially inconsistent. We answered the question whether the higher sensitivity of women and elderly persons is quantitatively meaningful. Specifically, we investigated if it is large enough to hamper the diagnosis, classification and follow-up of pain conditions by clinicians.Materials and Methods: From each age stratum (18– 20, 21– 30, 31– 40, 41– 50, 51– 60, 61– 70, 71– 80, and > 80 years), 40 pain-free women and 40 pain-free men were recruited. They rated the intensity of pressure of ten Newtons over ten seconds on an analogue zero to ten rating scale. The pressure was applied on their middle fingers and ear lobes with a threshold algometer. Centile curves visualized the sex- and age-dependent fluctuation of pressure sensitivity.Results: Over the entire age range from 20 to 80 years, the median curves fluctuated within the interval of less than two points. The distance between the median curves of men and women was also less than two points. On the average, the median difference was half a point on the finger (p = 0.249) and the ear lobe (p = 0.083).Conclusion: Less than two points is below the minimal clinically important difference for a zero to ten analogue pain rating scale; differences smaller than one point are even below the resolution of the scale. Sex differences and age fluctuations of pressure sensitivity are negligible.Keywords: age, sex, pain, sensitivity

Aversive childhood stress and its implications für expert reports using the example of chronic pain Abstract. Insurance-medical questions regarding the consequences of severe aversive childhood stress arise in the context of psychiatric and psychosomatic expert reports. In psychiatric expert reports, the insurance-medical weighting of disorders of thinking, feeling and behaviour is in the foreground. In psychosomatic expert reports the assessment of limited performance with regard to functional body symptoms are considered to be most important. The majority of expert reports in the psychosomatic field concern people with chronic pain disorders. Pain disorders can develop insidiously over the years or be triggered by accidents. For expert reports of chronic pain conditions, guidelines have been developed by the corresponding specialist bodies in Switzerland. These have been available in German and French since 2019 (www.sappm.ch). The following overview focuses on expert reports of chronic pain disorders and is based on the Swiss guidelines mentioned above. The demanding nature of writing such expert reports is also recognized by specialists in other European countries.

The sociolinguistic meaning of hand and nerves and their emotional expression Abstract. This article on the sociolinguistic occurrence of the hand and nerves in our everyday language reveals that the German language has a rich repertoire of metaphors and proverbs referring to fingers, hands, arms and nerves, expressing our feelings including pain. There are - on the one hand - not only plenty of expressions and phrases describing the physical purpose of the upper extremity, but - on the other hand - also countless metaphorical terms related to psychological, emotional or social contents. In contrast to medical terminology, everyday language does not hesitate to name the psychosocial dimension of things - High five!

Statt sich an Therapieschulen auszurichten, sollte auch bei der Behandlung chronischer Schmerzen schon in der Aus- und Weiterbildung von Psychotherapeut*innen eine auf allgemeinen Veränderungsmechanismen basierende Weiterbildung treten. Geeignete Vorschläge für mögliche störungsübergreifende Veränderungsmechanismen der kognitiv-verhaltenstherapeutisch ausgerichteten Psychotherapie finden sich bei Hayes und Hofmann (2018). Vorschläge für Veränderungsmechanismen und Interventionen in der Schmerzpsychotherapie jenseits des KVT-Ursprungs machen Lumley und Schubiner (2019). Die Liste der Veränderungsmechanismen und dazugehöriger Interventionen sollte nach aktuellem Wissensstand ständig erweitert werden. Schmerzpsychotherapie nach heutigen Standards ist letztlich Teil einer interdisziplinären multimodalen Schmerztherapie (IMST), die gemäß dem biopsychosozialen Krankheitsmodell stets eine interprofessionelle Zusammenarbeit erfordert., Instead of orienting oneself towards therapy schools, psychotherapy training based on general change mechanisms should also be introduced for the treatment of chronic pain. Suggestions for possible change mechanisms of cognitive-behaviorally (CBT)-based psychotherapy can be found in Hayes and Hofmann (2018). Proposals for change mechanisms and interventions in pain psychotherapy beyond the origin of CBT have been made by Lumley and Schubiner (2019). The list of mechanisms of change and related interventions should be continuously expanded according to current knowledge. Pain psychotherapy according to today’s standards is ultimately part of an interdisciplinary multimodal pain therapy (IMST), which according to the biopsychosocial disease model always requires interprofessional cooperation.

Prevention of aversive childhood experiences: social and health policy consequences Abstract. Neglect, as well as physical, psychological or sexual abuse increase the risk of developmental disorders and of long-term health consequences in adulthood. The prevention of maltreatment is therefore crucial. In Switzerland, a multi-layered prevention model mainly focuses on supporting the family. An improved social awareness of the importance of adequate childcare is in the interest of each individual as well as of the health care system and society as a whole.

Long-term consequences of aversive childhood experiences: effects on pain processing Abstract. Childhood experiences of stress due to neglect, physical, psychological or sexual abuse often lead to lasting changes in pain processing. Clinically, this is shown, among other things, in an increased sensitivity to pain, a stronger negative-affective connotation of pain and ultimately an increased risk of pain disorders in adulthood. George L. Engel already postulated in the 1960s a child's experience of stress can affect later pain behaviors. This narrative review sets out to summarize the current state of knowledge.