Skip to main content
Erschienen in: Der Schmerz 3/2006

01.06.2006 | Übersichten

Selektive C-Faser-Stimulation durch Stimulation winziger Hautareale

verfasst von: PD Dr. T. Weiss, W. H. R. Miltner

Erschienen in: Der Schmerz | Ausgabe 3/2006

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

In der Vergangenheit war es schwierig, die zentrale Verarbeitung primärer C-Faser-Afferenzen separat von der Verarbeitung von Aδ-Faser-Afferenzen zu untersuchen. Eine notwendige und hinreichende Bedingung für eine Untersuchung des C-Faser-Systems ist die selektive Stimulation der primären C-Faser-Afferenz bei gleichzeitiger Vermeidung der Aktivierung der Aδ-Afferenz. Die Stimulation winziger Hautareale ermöglicht eine solche selektive Aktivierung der C-Fasern.

Methoden und Ergebnisse

Wesentliche methodische Aspekte der Stimulation winziger Hautareale sowie Ergebnisse zu evozierten Potenzialen und deren Quellenlokalisationen werden referiert. Des Weiteren werden Potenzial und Möglichkeiten dieser Methode mit anderen Methoden zur Untersuchung der zentralen Verarbeitung humaner C-Faser-Afferenzen verglichen.

Schlussfolgerung

Mit der Methode der Stimulation winziger Hautareale steht ein einfaches Verfahren der selektiven Stimulation von C-Fasern zur Verfügung.
Literatur
1.
Zurück zum Zitat Arendt-Nielsen L, Bjerring P (1988) Reaction times to painless and painful CO2 laser and argon laser stimulation. Eur J Appl Physiol 58:266–273 Arendt-Nielsen L, Bjerring P (1988) Reaction times to painless and painful CO2 laser and argon laser stimulation. Eur J Appl Physiol 58:266–273
2.
Zurück zum Zitat Birbaumer N, Lutzenberger W, Montoya P, Larbig W, Unertl K, Töpfner S, Grodd W, Taub E, Flor H (1997) Effects of regional anesthesia on phantom limb pain are mirrored in changes in cortical reorganization. J Neurosci 17:5503–5508PubMed Birbaumer N, Lutzenberger W, Montoya P, Larbig W, Unertl K, Töpfner S, Grodd W, Taub E, Flor H (1997) Effects of regional anesthesia on phantom limb pain are mirrored in changes in cortical reorganization. J Neurosci 17:5503–5508PubMed
3.
Zurück zum Zitat Bragard D (1995) Perception and neurophysiological correlates of brief infrared laser pulses: influence of cutaneous stimulation area. Thesis, Université catholique de Louvain, Louvain Bragard D (1995) Perception and neurophysiological correlates of brief infrared laser pulses: influence of cutaneous stimulation area. Thesis, Université catholique de Louvain, Louvain
4.
Zurück zum Zitat Bragard D, Chen ACN, Plaghki L (1996) Direct isolation of ultra-late (C-fibre) evoked brain potentials by CO2 laser stimulation of tiny cutaneous surface areas in man. Neurosci Lett 209:81–84CrossRefPubMed Bragard D, Chen ACN, Plaghki L (1996) Direct isolation of ultra-late (C-fibre) evoked brain potentials by CO2 laser stimulation of tiny cutaneous surface areas in man. Neurosci Lett 209:81–84CrossRefPubMed
5.
Zurück zum Zitat Bromm B, Neitzel H, Tecklenburg A, Treede R (1983) Evoked cerebral potential correlates of c-fibre activity in man. Neurosci Lett 43:109–114CrossRefPubMed Bromm B, Neitzel H, Tecklenburg A, Treede R (1983) Evoked cerebral potential correlates of c-fibre activity in man. Neurosci Lett 43:109–114CrossRefPubMed
6.
Zurück zum Zitat Bromm B, Jahnke MT, Treede R-D (1984) Responses of human cutaneous afferents to CO2 laser stimuli causing pain. Exp Brain Res 55:158–166CrossRefPubMed Bromm B, Jahnke MT, Treede R-D (1984) Responses of human cutaneous afferents to CO2 laser stimuli causing pain. Exp Brain Res 55:158–166CrossRefPubMed
7.
Zurück zum Zitat Bromm B, Treede R-D (1984) Nerve fibre discharges, cerebral potentials and sensations induced by CO2 laser stimulation. Hum Neurobiol 3:33–40PubMed Bromm B, Treede R-D (1984) Nerve fibre discharges, cerebral potentials and sensations induced by CO2 laser stimulation. Hum Neurobiol 3:33–40PubMed
8.
Zurück zum Zitat Bromm B, Treede R-D (1987) Human cerebral potentials evoked by CO2 laser stimuli causing pain. Exp Brain Res 67:153–162CrossRefPubMed Bromm B, Treede R-D (1987) Human cerebral potentials evoked by CO2 laser stimuli causing pain. Exp Brain Res 67:153–162CrossRefPubMed
9.
Zurück zum Zitat Bromm B, Treede R-D (1991) Laser-evoked cerebral potentials in the assessment of cutaneous pain sensitivity in normal subjects and patients. Rev Neurol 147:625–643PubMed Bromm B, Treede R-D (1991) Laser-evoked cerebral potentials in the assessment of cutaneous pain sensitivity in normal subjects and patients. Rev Neurol 147:625–643PubMed
10.
Zurück zum Zitat Devor M, Carmon A, Frostig R (1982) Primary afferent and spinal sensory neurons that respond to brief pulses of intensive infrared laser radiation: a preliminary survey in rats. Exp Neurol 76:483–494CrossRefPubMed Devor M, Carmon A, Frostig R (1982) Primary afferent and spinal sensory neurons that respond to brief pulses of intensive infrared laser radiation: a preliminary survey in rats. Exp Neurol 76:483–494CrossRefPubMed
11.
Zurück zum Zitat Dutsch M, Marthol H, Stemper B, Brys M, Haendl T, Hilz MJ (2002) Small fiber dysfunction predominates in Fabry neuropathy. J Clin Neurophysiol 19:575–586CrossRefPubMed Dutsch M, Marthol H, Stemper B, Brys M, Haendl T, Hilz MJ (2002) Small fiber dysfunction predominates in Fabry neuropathy. J Clin Neurophysiol 19:575–586CrossRefPubMed
12.
Zurück zum Zitat Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, Larbig W, Taub E (1995) Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482–484CrossRefPubMed Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, Larbig W, Taub E (1995) Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482–484CrossRefPubMed
13.
Zurück zum Zitat Forss N, Raij TT, Seppa M, Hari R (2005) Common cortical network for first and second pain. NeuroImage 24:132–142CrossRefPubMed Forss N, Raij TT, Seppa M, Hari R (2005) Common cortical network for first and second pain. NeuroImage 24:132–142CrossRefPubMed
14.
Zurück zum Zitat Gehling M, Tryba M, Niebergall H, Hufschmidt A, Schild M, Geiger K (2003) Komplexe regionale Schmerzsyndrome CRPS I und II. Schmerz 17:309–316CrossRefPubMed Gehling M, Tryba M, Niebergall H, Hufschmidt A, Schild M, Geiger K (2003) Komplexe regionale Schmerzsyndrome CRPS I und II. Schmerz 17:309–316CrossRefPubMed
15.
Zurück zum Zitat Handwerker HO, Kobal G (1993) Psychophysiology of experimentally induced pain. Physiol Rev 73:639–671PubMed Handwerker HO, Kobal G (1993) Psychophysiology of experimentally induced pain. Physiol Rev 73:639–671PubMed
16.
Zurück zum Zitat Kakigi R, Shibasaki H, Tanaka K, Ikeda T, Oda KI, Endo C, Ikeda A, Neshige R, Kuroda Y, Miyata K, Yi S, Ikegawa S, Araki S (1991) CO2 laser-induced pain-related somatosensory evoked potentials in peripheral neuropathies: correlation between elektrophysiological and histological findings. Muscle Nerve 14:441–450CrossRefPubMed Kakigi R, Shibasaki H, Tanaka K, Ikeda T, Oda KI, Endo C, Ikeda A, Neshige R, Kuroda Y, Miyata K, Yi S, Ikegawa S, Araki S (1991) CO2 laser-induced pain-related somatosensory evoked potentials in peripheral neuropathies: correlation between elektrophysiological and histological findings. Muscle Nerve 14:441–450CrossRefPubMed
17.
Zurück zum Zitat Lankers J, Frieling A, Kunze K, Bromm B (1991) Ultralate cerebral potentials in a patient with hereditary motor and sensory neuropathy type I indicate preserved C-fibre function. J Neurol Neurosurg Psychiat 54:650–652PubMed Lankers J, Frieling A, Kunze K, Bromm B (1991) Ultralate cerebral potentials in a patient with hereditary motor and sensory neuropathy type I indicate preserved C-fibre function. J Neurol Neurosurg Psychiat 54:650–652PubMed
18.
Zurück zum Zitat Magerl W, Ali Z, Ellrich J, Meyer RA, Treede R-D (1999) C- and Aδ-fiber components of heat-evoked cerebral potentials in healthy human subjects. Pain 82:127–137CrossRefPubMed Magerl W, Ali Z, Ellrich J, Meyer RA, Treede R-D (1999) C- and Aδ-fiber components of heat-evoked cerebral potentials in healthy human subjects. Pain 82:127–137CrossRefPubMed
19.
Zurück zum Zitat Maihöfner C, Handwerker HO, Neundörfer B, Birklein F (2003) Patterns of cortical reorganization in complex regional pain syndrome. Neurology 61:1707–1715PubMed Maihöfner C, Handwerker HO, Neundörfer B, Birklein F (2003) Patterns of cortical reorganization in complex regional pain syndrome. Neurology 61:1707–1715PubMed
20.
21.
Zurück zum Zitat Mouraux A, Guerit JM, Plaghki L (2004) Refractoriness cannot explain why C-fiber laser-evoked brain potentials are recorded only if concomitant Aδ-fiber activation is avoided. Pain 112:16–26CrossRefPubMed Mouraux A, Guerit JM, Plaghki L (2004) Refractoriness cannot explain why C-fiber laser-evoked brain potentials are recorded only if concomitant Aδ-fiber activation is avoided. Pain 112:16–26CrossRefPubMed
22.
Zurück zum Zitat Müller H (2000) Neuroplastizität und Schmerzchronifizierung. Anästhesiol Intensivmed Notfallmed Schmerzther 35:274–284 Müller H (2000) Neuroplastizität und Schmerzchronifizierung. Anästhesiol Intensivmed Notfallmed Schmerzther 35:274–284
23.
Zurück zum Zitat Nahra H, Plaghki L (2003) The effects of A-fiber pressure block on perception and neurophysiological correlates of brief non-painful and painful CO2 laser stimuli in humans. Eur J Pain 7:189–199CrossRefPubMed Nahra H, Plaghki L (2003) The effects of A-fiber pressure block on perception and neurophysiological correlates of brief non-painful and painful CO2 laser stimuli in humans. Eur J Pain 7:189–199CrossRefPubMed
24.
Zurück zum Zitat Nix WA (2004) Die Bandbreite der Neuropathie bei Diabetes und gestörter Glukosetoleranz. Schmerz 18:327–328CrossRefPubMed Nix WA (2004) Die Bandbreite der Neuropathie bei Diabetes und gestörter Glukosetoleranz. Schmerz 18:327–328CrossRefPubMed
25.
Zurück zum Zitat Ochoa J, Mair WGP (1976) The normal sural nerve in man: I. ultrastructure and number of fibres and cells. Acta Neuropathol (Berlin) 13:197–216 Ochoa J, Mair WGP (1976) The normal sural nerve in man: I. ultrastructure and number of fibres and cells. Acta Neuropathol (Berlin) 13:197–216
26.
Zurück zum Zitat Olausson H, Lamarre Y, Backlund H, Morin C, Wallin BG, Starck G, Ekholm S, Strigo I, Worsley K, Vallbo AB, Bushnell MC (2002) Unmyelinated tactile afferents signal touch and project to insular cortex. Nat Neurosci 5:900–904CrossRefPubMed Olausson H, Lamarre Y, Backlund H, Morin C, Wallin BG, Starck G, Ekholm S, Strigo I, Worsley K, Vallbo AB, Bushnell MC (2002) Unmyelinated tactile afferents signal touch and project to insular cortex. Nat Neurosci 5:900–904CrossRefPubMed
27.
Zurück zum Zitat Opsommer E, Masquelier E, Plaghki L (1999) Determination of nerve conduction velocity of C-fibres in humans from thermal thresholds to contact heat (thermode) and from evoked brain potentials to radiant heat (CO2 laser). Clin Neurophysiol 29:411–422 Opsommer E, Masquelier E, Plaghki L (1999) Determination of nerve conduction velocity of C-fibres in humans from thermal thresholds to contact heat (thermode) and from evoked brain potentials to radiant heat (CO2 laser). Clin Neurophysiol 29:411–422
28.
Zurück zum Zitat Opsommer E, Weiss T, Miltner WHR, Plaghki L (2001) Scalp topography of ultralate (C-fibres) evoked potentials following thulium YAG laser stimuli to tiny skin surface areas in humans. Clin Neurophysiol 112:1868–1874CrossRefPubMed Opsommer E, Weiss T, Miltner WHR, Plaghki L (2001) Scalp topography of ultralate (C-fibres) evoked potentials following thulium YAG laser stimuli to tiny skin surface areas in humans. Clin Neurophysiol 112:1868–1874CrossRefPubMed
29.
Zurück zum Zitat Opsommer E, Weiss T, Plaghki L, Miltner WHR (2001) Dipole analysis of ultralate (C-fibres) evoked potentials after laser stimulation of tiny cutaneous surface areas in humans. Neurosci Lett 298:41–44CrossRefPubMed Opsommer E, Weiss T, Plaghki L, Miltner WHR (2001) Dipole analysis of ultralate (C-fibres) evoked potentials after laser stimulation of tiny cutaneous surface areas in humans. Neurosci Lett 298:41–44CrossRefPubMed
30.
Zurück zum Zitat Orstavik K, Weidner C, Schmidt R, Schmelz M, Hilliges M, Jorum E, Handwerker H, Torebjörk E (2003) Pathological C-fibres in patients with a chronic painful condition. Brain 126:567–578CrossRefPubMed Orstavik K, Weidner C, Schmidt R, Schmelz M, Hilliges M, Jorum E, Handwerker H, Torebjörk E (2003) Pathological C-fibres in patients with a chronic painful condition. Brain 126:567–578CrossRefPubMed
31.
Zurück zum Zitat Ossipov MH, Zhang ET, Carvajal C, Gardell L, Quirion R, Dumont Y, Lai J, Porreca F (2002) Selective mediation of nerve injury-induced tactile hypersensitivity by neuropeptide Y. J Neurosci 22:9858–9867PubMed Ossipov MH, Zhang ET, Carvajal C, Gardell L, Quirion R, Dumont Y, Lai J, Porreca F (2002) Selective mediation of nerve injury-induced tactile hypersensitivity by neuropeptide Y. J Neurosci 22:9858–9867PubMed
32.
Zurück zum Zitat Plaghki L, Mouraux A (2002) Brain responses to signals ascending through C-fibers. Int Congr Ser 1232:181–192CrossRef Plaghki L, Mouraux A (2002) Brain responses to signals ascending through C-fibers. Int Congr Ser 1232:181–192CrossRef
33.
Zurück zum Zitat Plaghki L, Mouraux A (2003) How do we selectively activate skin nociceptors with a high power infrared laser? Physiology and biophysics of laser stimulation. Clin Neurophysiol 33:269–277 Plaghki L, Mouraux A (2003) How do we selectively activate skin nociceptors with a high power infrared laser? Physiology and biophysics of laser stimulation. Clin Neurophysiol 33:269–277
34.
Zurück zum Zitat Ploner M, Gross J, Timmermann L, Schnitzler A (2002) Cortical representation of first and secon pain sensation in humans. Proc Natl Acad Sci USA 99:12444–12448CrossRefPubMed Ploner M, Gross J, Timmermann L, Schnitzler A (2002) Cortical representation of first and secon pain sensation in humans. Proc Natl Acad Sci USA 99:12444–12448CrossRefPubMed
35.
Zurück zum Zitat Price DD (1988) Psychological and neural mechanisms of pain. Raven Press, New York Price DD (1988) Psychological and neural mechanisms of pain. Raven Press, New York
36.
Zurück zum Zitat Price DD (1996) Selective activation of A-delta and C nociceptive afferents by different parameters of nociceptive heat stimulation: a tool for analysis of central mechanisms of pain. Pain 68:1–3CrossRefPubMed Price DD (1996) Selective activation of A-delta and C nociceptive afferents by different parameters of nociceptive heat stimulation: a tool for analysis of central mechanisms of pain. Pain 68:1–3CrossRefPubMed
37.
Zurück zum Zitat Qiu YH, Inui K, Wang XH, Tran TD, Kakigi R (2001) Conduction velocity of the spinothalamic tract in humans as assessed by CO2 laser stimulation of C-fibers. Neurosci Lett 311:181–184CrossRefPubMed Qiu YH, Inui K, Wang XH, Tran TD, Kakigi R (2001) Conduction velocity of the spinothalamic tract in humans as assessed by CO2 laser stimulation of C-fibers. Neurosci Lett 311:181–184CrossRefPubMed
38.
Zurück zum Zitat Qiu YH, Fu Q, Wang XH, Tran TD, Inui K, Iwase S, Kakigi R (2003) Microneurographic study of C-fiber discharges induced by CO2 laser stimulation in humans. Neurosci Lett 353:25–28CrossRefPubMed Qiu YH, Fu Q, Wang XH, Tran TD, Inui K, Iwase S, Kakigi R (2003) Microneurographic study of C-fiber discharges induced by CO2 laser stimulation in humans. Neurosci Lett 353:25–28CrossRefPubMed
39.
Zurück zum Zitat Reinert A, Treede RD, Bromm B (2000) The pain inhibiting pain effect: an electrophysiological study in humans. Brain Res 862:103–110CrossRefPubMed Reinert A, Treede RD, Bromm B (2000) The pain inhibiting pain effect: an electrophysiological study in humans. Brain Res 862:103–110CrossRefPubMed
40.
Zurück zum Zitat Rommel O, Gehring M, Dertwinkel R, Witscher K, Zenz M, Malin JP, Jänig W (1999) Hemisensory impairment in patients with complex regional pain syndrome. Pain 80:95–101CrossRefPubMed Rommel O, Gehring M, Dertwinkel R, Witscher K, Zenz M, Malin JP, Jänig W (1999) Hemisensory impairment in patients with complex regional pain syndrome. Pain 80:95–101CrossRefPubMed
41.
Zurück zum Zitat Schmidt RF, Schaible HG, Messlinger K, Heppelmann B, Hanesch U, Pawlak M (1994) Silent and active nociceptors: structure, functions, and clinical implications. In: Gebhart GF, Hammond DL, Jensen TS (eds) Proceedings of the 7th World Congress of Pain. IASP Press, Seattle, pp 213–250 Schmidt RF, Schaible HG, Messlinger K, Heppelmann B, Hanesch U, Pawlak M (1994) Silent and active nociceptors: structure, functions, and clinical implications. In: Gebhart GF, Hammond DL, Jensen TS (eds) Proceedings of the 7th World Congress of Pain. IASP Press, Seattle, pp 213–250
42.
Zurück zum Zitat Tarkka IM, Treede R-D (1993) Equivalent electrical source analysis of pain-related somatosensory evoked potentials elicited by a CO2 laser. J Clin Neurophysiol 10:513–519PubMed Tarkka IM, Treede R-D (1993) Equivalent electrical source analysis of pain-related somatosensory evoked potentials elicited by a CO2 laser. J Clin Neurophysiol 10:513–519PubMed
43.
Zurück zum Zitat Tran TD, Lam K, Hoshiyama M, Kakigi R (2001) A new method for measuring the conduction velocities of A beta-, A delta- and C-fibers following electric and CO2 laser stimulation in humans. Neurosci Lett 301:187–190CrossRefPubMed Tran TD, Lam K, Hoshiyama M, Kakigi R (2001) A new method for measuring the conduction velocities of A beta-, A delta- and C-fibers following electric and CO2 laser stimulation in humans. Neurosci Lett 301:187–190CrossRefPubMed
44.
Zurück zum Zitat Tran TD, Inui K, Hoshiyama M, Lam K, Kakigi R (2002) Conduction velocity of the spinothalamic tract following CO2 laser stimulation of C-fibers in humans. Pain 95:125–131CrossRefPubMed Tran TD, Inui K, Hoshiyama M, Lam K, Kakigi R (2002) Conduction velocity of the spinothalamic tract following CO2 laser stimulation of C-fibers in humans. Pain 95:125–131CrossRefPubMed
45.
Zurück zum Zitat Treede R-D (2003) Neurophysiological studies of pain pathways in peripheral and central nervous system disorders. J Neurol 250:1152–1161CrossRefPubMed Treede R-D (2003) Neurophysiological studies of pain pathways in peripheral and central nervous system disorders. J Neurol 250:1152–1161CrossRefPubMed
46.
Zurück zum Zitat Truini A, Haanpaa M, Zucchi R, Galeotti F, Iannetti GD, Romaniello A, Cruccu G (2003) Laser-evoked potentials in post-herpetic neuralgia. Clin Neurophysiol 114:702–709CrossRefPubMed Truini A, Haanpaa M, Zucchi R, Galeotti F, Iannetti GD, Romaniello A, Cruccu G (2003) Laser-evoked potentials in post-herpetic neuralgia. Clin Neurophysiol 114:702–709CrossRefPubMed
47.
Zurück zum Zitat Von Giesen HJ, Weiss P, Arendt G, Hefter H (2003) Potential C-fiber damage in Wilson’s disease. Acta Neurol Scand 108:257–261CrossRefPubMed Von Giesen HJ, Weiss P, Arendt G, Hefter H (2003) Potential C-fiber damage in Wilson’s disease. Acta Neurol Scand 108:257–261CrossRefPubMed
48.
Zurück zum Zitat Weiss T, Kumpf K, Ehrhardt J, Gutberlet I, Miltner WHR (1997) A bioadaptive approach for experimental pain research in humans using laser-evoked brain potentials. Neurosci Lett 227:95–98CrossRefPubMed Weiss T, Kumpf K, Ehrhardt J, Gutberlet I, Miltner WHR (1997) A bioadaptive approach for experimental pain research in humans using laser-evoked brain potentials. Neurosci Lett 227:95–98CrossRefPubMed
49.
Zurück zum Zitat Weiss T, Miltner WHR, Dillmann J (2003) The influence of semantic priming on event-related potentials to painful laser-heat stimuli in migraine patients. Neurosci Lett 340:135–138CrossRefPubMed Weiss T, Miltner WHR, Dillmann J (2003) The influence of semantic priming on event-related potentials to painful laser-heat stimuli in migraine patients. Neurosci Lett 340:135–138CrossRefPubMed
50.
Zurück zum Zitat Weiss T, Miltner WHR, Liepert J, Meissner W, Taub E (2004) Rapid functional plasticity in the primary somatomotor cortex and perceptual changes after nerve block. Eur J Neurosci 20:3413–3423CrossRefPubMed Weiss T, Miltner WHR, Liepert J, Meissner W, Taub E (2004) Rapid functional plasticity in the primary somatomotor cortex and perceptual changes after nerve block. Eur J Neurosci 20:3413–3423CrossRefPubMed
51.
Zurück zum Zitat Weiss T, Spohn D, Meyer A, Miltner WHR (2004) Ultra-late evoked potentials following stimulation of tiny skin surface areas in humans. Clin Neurophysiol 35:211 Weiss T, Spohn D, Meyer A, Miltner WHR (2004) Ultra-late evoked potentials following stimulation of tiny skin surface areas in humans. Clin Neurophysiol 35:211
52.
Zurück zum Zitat Willis WD (1985) The pain system. The neural basis of nociceptive transmission in the mammalian nervous system. Karger, Basel Willis WD (1985) The pain system. The neural basis of nociceptive transmission in the mammalian nervous system. Karger, Basel
Metadaten
Titel
Selektive C-Faser-Stimulation durch Stimulation winziger Hautareale
verfasst von
PD Dr. T. Weiss
W. H. R. Miltner
Publikationsdatum
01.06.2006
Verlag
Springer-Verlag
Erschienen in
Der Schmerz / Ausgabe 3/2006
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI
https://doi.org/10.1007/s00482-005-0416-9

Weitere Artikel der Ausgabe 3/2006

Der Schmerz 3/2006 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.