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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-1466

Palla, S (2002). Grundsätze zur Therapie des myoarthropathischen Schmerzes. Der Schmerz, 16(5):373-380.

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Deutsch: Der myoarthropathische Schmerz ist eine häufige Ursache für Kopf-, Kiefer- und Gesichtsschmerzen, wobei die Tendomyopathie bei der Schmerzgenese im Vordergrund steht. Die Schmerzintensität fluktuiert oft mit Abwechslung zwischen schmerzfreien und schmerzhaften Perioden. Vor allem leichte bis mäßig starke myoarthropathische Schmerzen haben die Tendenz, spontan zu verschwinden. Jedenfalls können sie mit einfachen, reversiblen Maßnahmen (Aufklärung, Selbstbeobachtung, Analgetika, Physiotherapie und okklusale Schienen) gelindert werden. Nur bei einem kleinen Teil der Patienten chronifiziert der Schmerz, so dass ein multimodaler therapeutischer Ansatz notwendig wird, um sowohl die somatische als auch die nichtsomatische, d. h. die affektive, emotionale, kognitive und verhaltensbezogene Schmerzkomponente zu behandeln. Zur Behandlung der somatischen Komponente können trizyklische Antidepressiva eingesetzt werden, während die Therapie der nichtsomatischen Komponente eine kognitive, verhaltensorientierte Therapie benötigt.

English: The myoarthropathic pain is the major source of orofacial pain. The diagnosis is not always easy because the diagnostic signs are not pathognomonic and they may occur also with other pain disorders. The pain intensity fluctuates, and mild to medium intensity pain has the tendency to subside spontaneously or can be alleviated with simple, non-invasive therapies as counseling, self-control, analgesics, physiotherapy, and occlusal appliances. For most patients a combination of counseling, self-control and physiotherapy (home program) is sufficient to relieve the pain. Occlusal appliances should therefore be used only if these modalities fail or in presence of pain on awakening, ostheoarthritis, a painful discopathy, and/or a malocclusion caused by condylar remodeling secondary to ostheoarthrosis.Only in a small percentage of patients the myoarthropathic pain persists and becomes chronic. These patients need a multimodal therapy, according to the biopsychosocial pain model. In addition to the modalities just described, the treatment must address also the affective, emotional, cognitive, and behavioral pain component and be tailored to the single patient based on his/her psychosocial and constitutional characteristics. The goal is not pain relieve but improvement of the quality of life by teaching the patient more efficient pain coping strategies by means of behavioral and relaxation therapy. In addition, tricyclic antidepressants may be used in order to treat the somatic pain component caused by the neuroplastic changes that take place in the central nervous system in chronic pain conditions.


7 citations in Web of Science®
11 citations in Scopus®
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Additional indexing

Other titles:Principles on therapy of myoarthropathic pain
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Center for Dental Medicine > Clinic for Fixed and Removable Prosthodontics
Dewey Decimal Classification:610 Medicine & health
Date:1 September 2002
Deposited On:11 Feb 2008 12:23
Last Modified:05 Apr 2016 12:18
Publisher DOI:10.1007/s00482-002-0153-2
PubMed ID:12235501

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