??e? te???????e?, ?e???

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??e? te???????e?, ?e???ß??????a ?a? ?p?st?µe? t??
S?µpe??f????

• ?????? S?a????a

??T? ?e?µe???? e??µ??? 2005
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- ß??????a t?? ?e?????? s?st?µat??
Ne???ß??????a
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????? - ???sµ??

• ??s??est? a?s??s? p?? s???de?e? p?a?µat??? ?
  ep??e?µe?? ?atast??f? ?st??
• ?e?t?????a/d?s?e?t?????a p??a ? (e?e???t???)
  s?µas?a t?? p?????
• S?st?µa p??e?d?p???s?? p???? -gt d?a??p?
  e?e??sµat?? p?? t?? p???a?e? -gt eµp?d??e?
  pe?a?t??? ß??ße?
• ???a???? t?? ep????s??/??at?e??? p???? a????e?
  t?? p??stas?a t?? pe?????? p?? p???e?
• S???e??? ??a?s??s?a st?? ????
• ??????? p???? (p.?. ?e?µat?e?d?? a????t?da, ??p)
  - de? e??p??ete? ?a???a s??p? ? e??a?
• p??? p?? ?atast??f???? ap? ?s? apa?te? ? ?p??a
  ß???????? s??p?µ?t?ta (p.?. µetastat????
  ?a??????)
• nociception vs. pain
• ??s??t???a?? s?st?µa p?? µetaf??e? ?a?
  ??d???p??e? ?d????? e?e??sµata
• ????? (?p??e?µe???? eµpe???a)

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??d? p????

• Acute vs. chronic
• ß?a???
• ????
• e????a a?a?????s?µ? a?t??
• e?t?p?sµ???? p???? p?? e?d??eta? ?a ap???e?
• e????? a?t?µet?p?s? µe fa?µa?e?t??? a????

gt 6 µ??e? p???? p?? ep?µ??e? p??a? t??
a?t??? d?s???a a?a?????s?µ? a?t?? ????te??
e?t?p?sµ???? p?? d?s???? fa?µa?e?t???
a?t?µet?p?s?
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??d? p????

• Nociceptive vs. neuropathic (?e???p??e?e?) vs.
  psychogenic (?????e???)
• ?p?t??esµa t?a?µat?sµ?? se ?st??? t?? s?µat??
• cutaneous (ep?de?µ????)
• - p????? ap????e??, a???ß?? e?t?p?sµ??, ß?a???
  ?a? ????
• somatic (s?µat???? t????te?, ????a?a,
  a??e?a)
• - ????te?e? ap????e??, ????te?? ????, ????te??
  e?t?p?sµ????
• visceral (???a????? es?te???? ???a?a,
  ?a?d??, ??te?a, ??p)
• - µ???? p????t?ta ap????e??, d?s?????
  e?t?p?sµ??, referred pain
• ?p?t??esµa ß??ß?? st?? ?e?????? ap????e??,
  ??t?a?? µ?e?? ? e???fa??
• fa?tasµ??? ???a
• ?e??a???a
• - ?atast??f?/t?a?µa t?? ?e?????? ap????e??
  a?t?? ?a?ea?t?? (???? t?a?µat??,
• a???ste?a? - ???a??, ??p?? ??st??a? - ?
  t?????? d?se?? fa?µ????) -gt de? µp????? ?a
• µetad?s??? s?µata -gt e???fa??? (pa?)e?µ??e?e?
  µ???µata p????
• 3. ?µpe???a p???? ????? (p??fa??) ???a???? a?t?a
  - s?????? ?e???? µe ???a???? a?t??, a??? ??tas?
  ?a? d????e?a de? µp????? ?a e???????? ß?se?
  a?t??. Te?ape?a pe???aµß??e? ????at????
  a?t?µet?p?s? (fa?µa?e?t??? a??? ?a?
  ?????e?ape?t???).

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??e??sµata p?? p???a???? p???
???a???? (µe????? ??tas??) p?es?, ts?µp?µa,
sf???µ?, st?aµp?????µa t?p??? ?atast??f? ?st??
-gt ??µ??? (???a ?, ? ??µ???? e??se?? p.?.
capsaiscin) Te?µ??? (?pe?ß????? ??st? ?
?pe?ß????? ????)
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???sa?µ??? (adaptation)
e????sµa
ap????s?
?a????? p??sa?µ???
µe???? p??sa?µ???
????? p??sa?µ???
?????????? ????? p??sa?µ?????  ??????µ?a
e????e?a?  ??????µ?a s?µ?t??
 µetaßa??µe?? ???µa?a e?a?s??s?a? pe??pt?se??
?p?? t? s?µa?t??? e??a? t? s?et??? ?a? ??? t?
ap???t? s?µa
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?p?peda ?a? e?d? p??sa?µ????

• ?a??de??µa p?????? p??sa?µ?????
• ?sf??t??? e?e??sµata
• ?a??de??µa ???e???? p??sa?µ?????
• proprioception
• p????
• ?a??de??µa µe????? p??sa?µ?????
• f?t??p?d??e??
• ?a??de??µa e??sµ?? se ???t??? e????sµa ?aµ????
  ??tas?? -gt p??sa?µ????
• p??sa?µ??? se ep?ped? ?p?d????? s?µa de?
  ?p???e? st? ?S
• -gt e????sµa de? ?f?stata? ??a t?? s???e???µ???
  ???a??sµ?
• p??sa?µ??? se ep?ped? ?e?t????? ?S (e??sµ??)
  s?µa ?p???e? a??? ??? ap?
• t?? sfa??a p??s???? -gt d??at?t?ta epa?af????
  e?t?? a?t???pt???? ped???

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hyperalgesia

• ????µ??? e?a?s??s?a ?a? d?e?e?s?µ?t?ta t??
  pe?????? ???? ap? t??
• ?atest?aµµ??? ?st?.
• ??t?a e?a?s??t?p???s? t?? ?p?de????? t?? p????
  ap? ??s?e? p?? e???????ta? ap? t???
  ?atest?aµµ????? ?st???

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??t?-?staµ?????
?
?
?sp?????
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S?st?µata µetaf????/??d???p???s?? µ???µ?t?? p????
????? ???eta? s??e?d?t??
????? ???eta? a?t???pt??
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S?st?µata µetaf????/??d???p???s?? µ???µ?t?? p????
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??? e??????ta??

• Referred pain (??t?p?? p????, a?ta????as? p????)
• Fa???µe?? placebo
• (p.?. µe??t? µe 56 f??t?t?? ?p?? ?? µ?s?? ??aßa?
  ??eµ?st??? ?a? ?? ????? µ?s??
• d?e?e?t???)
• Ep?d?as? ??????????? pa?a???t?? st??
  ?p??e?µe???? eµpe???a t?? p????
• (p.?. pa??de??µa t?a?µat?sµ?? ?at? t?? d????e?a
  ????s??, p???µ??, ??p)
• (p.?. µe??t? ?p?? µete??e???t???? as?e?e??
  ?????? ???s? ????te??? a?a???t????)

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Referred pain
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?e?t????? ??e???? a?t?????? p????
??e?t???? d???e?s? ??p???? pe?????? -gt µe??s?
p???? ? ?fe??eta? se e?e???p???s? ?e??????
?d?? p?? e??????? µetaf??? a?e???µe???
µ???µ?t??

• ?p?? ?a? pa?????a a?t?? e??a?
• ?s???? a?a???t???
• ?
• ???pe? ?a ?p?????? e?d????
• ?p?d??e??
• ?
• ???pe? ?a ?p?????? e?d??e??
• ?p??e?d?
• ?
• ??a?????? e?d??e??? ?p??e?d??
• e?d??f??e?, e??efa???e?, d????f??e?

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?e?t????? ??e???? a?t?????? p????
Fa???µe?? placebo µp??e? ?a eµp?d?ste? µe
f??µa?a p?? de? ep?t??p??? t??
?e?t?????a ?p??e?d?? ?p?d?????! ??s? a?t?? t??
?d?? fa??eta? p?? µp????? ?a e????????
fa???µe?a ?p?? ? ?????a t?? p???? se
?atast?se?? e??????s??, ?a??? ?a? ? s?et???t?ta
t?? a?s??s?? t?? p???? a?af?????
µe ??????????? s?????e? ße????sµ??, ?p??s? -
?
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???/p?? d???? ta a?a???t??? f??µa?a (pa?s?p??a)?

• ?p??e?d? (p???? ?s????)
•  ???f???, ??de???,
• methadone, ??p
•  ?e?t???? d??s?
• staµat??? a?e???µe?a
• µ???µata
•  pa?e????e?e? ??sta,
• ?a?t?a, d?s??????t?ta,
• e??sµ??

4. ???a  a?t??ata???pt???,  a?t?-ep???pt???
(?µ???a??e?, ?e???p??e?e?)  ??st?, ????
TENS ep?de?µ??? ??e?t???? d???e?s?  ße????sµ??
 Biofeedback ?a????s?, ?p??s?, ??p

• S????? pa?s?p??a - a?t?f?e?µ???d?
•  asp?????, ibuprofen, ??p
•  pe??fe??a?? d??s? µe??s? f?e?µ????
• ?/?a? µe??s? a?s??s?? p????
•  pa?e????e?e? e?e??sµ?? st?µ????,
• d?s?e?t?????a ?pat??

3. ??p??? a?a?s??t???  ??d??a???  pe??fe??a??
d??s? staµat??? µet?d?s? ?e?????? ?se??
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?e??fe??a?? d??s? a?a???t????
??t?-?staµ?????
?sp?????, ibuprofen
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s????????ta?

• Se s??s? µe ???a a?s??t???a?? s?st?µata, t?
  s?st?µa p????
•  e?e???t??? p?? pa?a?? -gt p?? p??t?????
•  ap??? ?p?d??e??, ????? µ??f????????
  e?e?d??e?se??
•  a??? µet?d?s? µ???µ?t?? (????e? ?????
  µ?e????)
•  µe???a ?p?de?t??? ped?a -gt ??? a???ß??
  e?t?p?sµ?? e?e??sµat??
•  µ???? p????t?ta ?e?????? ap????e?? -gt ???
  a???ß?? e?t?p?sµ??
• e?e??sµat??
•  ?p? t?? ??e??? ?e?t????? ?e?????? s?st?µat??
  (???????????
• pa?????te?, placebo, ??p)

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