nach oben

Erschienen in:

2022 | OriginalPaper | Buchkapitel

2. Schmerzen bei chronischen nicht entzündlichen und entzündlichen Erkrankungen

verfasst von : Wolfgang Laube

Erschienen in: Schmerztherapie ohne Medikamente

Verlag: Springer Berlin Heidelberg

Einloggen, um Zugang zu erhalten

Zusammenfassung

Es gibt keinen diagnostischen „Goldstandard“ zur Schmerzklassifizierung und damit zur Differenzierung von Schmerzkrankheiten. Zu einer zentralen Sensibilisierung kommt es bei der Osteoarthritis und der rheumatischen Arthritis. Sie bestimmt die Schwere der Symptome. Bei der Fibromyalgie ist sie das Charakteristikum, und periphere Veränderungen prägen das Schmerzbild und die Ermüdbarkeit und steigern die Intensität der Sensibilisierung. Der Grad der Sensibilisierung, diagnostiziert anhand des psychopathologischen Profils, könnte in Zukunft zum Differenzierungsmerkmal zwischen den Schmerzerkrankungen werden.

Insgesamt kann die Schlussfolgerung gezogen werden, dass die therapeutische Schmerzhemmung nach dem Prinzip „Schmerz hemmt Schmerz“ bei allen degenerativen, rheumatischen und primär zentralen Erkrankungen wie der FM nicht nur keine Kontraindikation darstellt, sondern indiziert ist, um über die Schmerzhemmung eine ausreichende Belastbarkeit für aktive Interventionen erreichen zu können.

Affaitati G, Costantini R, Tana C, Cipollone F, Giamberardino MA. Co-occurrence of pain syndromes. J Neural Transm (Vienna). 2020;127(4):625–46. https://doi.org/10.1007/s00702-019-02107-8. Epub 2019 Nov 29.CrossRef

Alonso-Blanco C, Fernandez-de-Las-Penas C, Morales-Cabezas M, Zarco-Moreno P, Ge H, Florez-Garcia M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. 2011;27:405–13.CrossRefPubMed

Alonso-Blanco C, Fernández-de-Las-Peñas C, de-la-Llave-Rincón AI, Zarco-Moreno P, Galán-Del-Río F, Svensson P. Characteristics of referred muscle pain to the head from active trigger points in women with myofascial temporomandibular pain and fibromyalgia syndrome. J Headache Pain. 2012;13(8):625–37. https://doi.org/10.1007/s10194-012-0477-y. Epub 2012 Aug 31.CrossRefPubMedPubMedCentral

Angiolilli C, Kabala PA, Grabiec AM, Van Baarsen IM, Ferguson BS, Garcia S, Malvar Fernandez B, McKinsey TA, Tak PP, Fossati G, Mascagni P, Baeten DL, Reedquist KA. Histone deacetylase 3 regulates the inflammatory gene expression programme of rheumatoid arthritis fibroblast-like synoviocytes. Ann Rheum Dis. 2017;76:277–85.CrossRefPubMed

Antony B, Venn A, Cicuttini F, March L, Blizzard L, Dwyer T, Cross M, Jones G, Ding C. Association of physical activity and physical performance with tibial cartilage volume and bone area in young adults. Arthritis Res Ther. 2015a;17:298. https://doi.org/10.1186/s13075-015-0813-0.CrossRefPubMedPubMedCentral

Antony B, Jones G, Venn A, Cicuttini F, March L, Blizzard L, Dwyer T, Cross M, Ding C. Childhood physical performance measures and adulthood knee cartilage volume and bone area: a 25-year cohort study. Arthritis Care Res. 2015b;67(9):1263–71. https://doi.org/10.1002/acr.22588.CrossRef

Bourgaize S, Newton G, Kumbhare D, Srbely J. A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management. J Can Chiropr Assoc. 2018;62(1):26–41.PubMedPubMedCentral

Buckland J. Rheumatoid arthritis: TNF targets histones to loosen chromatin in RA FLS. Nat Rev Rheumatol. 2014;10:636.CrossRefPubMed

Casale R, Sarzi-Puttini P, Atzeni F, Gazzoni M, Buskila D, Rainoldi A. Central motor control failure in fibromyalgia: a surface electromyography study. BMC Musculoskelet Disord. 2009;10:78. https://doi.org/10.1186/1471-2474-10-78.CrossRefPubMedPubMedCentral

Cordero MD, De Miguel M, Moreno Fernández AM, Carmona López IM, Garrido Maraver J, Cotán D, Gómez Izquierdo L, Bonal P, Campa F, Bullon P, Navas P, Sánchez Alcázar JA. Mitochondrial dysfunction and mitophagy activation in blood mononuclear cells of fibromyalgia patients: implications in the pathogenesis of the disease. Arthritis Res Ther. 2010a;12(1):R17. https://doi.org/10.1186/ar2918. Epub 2010 Jan 28.CrossRefPubMedPubMedCentral

Cordero MD, Alcocer-Gómez E, Cano-García FJ, de Miguel M, Sánchez-Alcázar JA, Moreno Fernández AM. Low levels of serotonin in serum correlates with severity of fibromyalgia. Med Clin (Barc). 2010b;135(14):644–6. https://doi.org/10.1016/j.medcli.2010.05.009. Epub 2010 Jun 29.CrossRef

Crump C, Sundquist J, Winkleby MA, Sieh W, Sundquist K. Physical fitness among Swedish military conscripts and long-term risk for type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2016a;164(9):577–84. https://doi.org/10.7326/M15-2002. Epub 2016 Mar 8.CrossRefPubMedPubMedCentral

Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of physical fitness and body mass index on the risk of hypertension. JAMA Intern Med. 2016b;176(2):210–6. https://doi.org/10.1001/jamainternmed.2015.7444.CrossRefPubMedPubMedCentral

Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of physical fitness and body mass index on risk of stroke: a national cohort study. Int J Stroke. 2016c;11(6):683–94. https://doi.org/10.1177/1747493016641961. Epub 2016 Mar 25.CrossRefPubMedPubMedCentral

Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of obesity and physical fitness on risk of ischemic heart disease. Int J Obes. 2017a;41(2):255–61. https://doi.org/10.1038/ijo.2016.209. Epub 2016 Nov 21.CrossRef

Crump C, Sundquist J, Winkleby MA, Sundquist K. Aerobic fitness, muscular strength and obesity in relation to risk of heart failure. Heart. 2017b;103(22):1780–7. https://doi.org/10.1136/heartjnl-2016-310716. Epub 2017 May 12.CrossRefPubMed

Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of aerobic fitness, strength, and obesity on mortality in men. Am J Prev Med. 2017c;52(3):353–61. https://doi.org/10.1016/j.amepre.2016.10.002. Epub 2016 Nov 14.CrossRefPubMed

Dikalov SI, Dikalova AE. Contribution of mitochondrial oxidative stress to hypertension. Curr Opin Nephrol Hypertens. 2016;25(2):73–80. https://doi.org/10.1097/MNH.0000000000000198.CrossRefPubMedPubMedCentral

Fearon U, Canavan M, Biniecka M, Veale DJ. Hypoxia, mitochondrial dysfunction and synovial invasiveness in rheumatoid arthritis. Nat Rev Rheumatol. 2016;12(7):385–97. https://doi.org/10.1038/nrrheum.2016.69. Epub 2016 May 26.CrossRefPubMed

Fernández-de-Las-Peñas C, Arendt-Nielsen L. Myofascial pain and fibromyalgia: two different but overlapping disorders. Pain Manag. 2016;6(4):401–8. https://doi.org/10.2217/pmt-2016-0013. Epub 2016 Jun 14.CrossRefPubMed

Fernandez-de-Las-Penas C, Galan-Del-Rio F, Alonso-Blanco C, Jimenez-Garcia R, Arendt-Nielsen L, Svensson P. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disorders. J Pain. 2010;11:1295–304.CrossRefPubMed

Fingleton C, Smart K, Moloney N, Fullen BM, Doody C. Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(7):1043–56. https://doi.org/10.1016/j.joca.2015.02.163. Epub 2015 Mar 5.CrossRef

Foley S, Ding C, Cicuttini F, Jones G. Physical activity and knee structural change: a longitudinal study using MRI. Med Sci Sports Exerc. 2007;39(3):426–34. https://doi.org/10.1249/mss.0b013e31802d97c6.CrossRefPubMed

Frank F. Das metabolische Syndrom, Arteriosklerose und degenerative Erkrankung des Stütz- und Bewegungsapparates. Arbeitsmed, Sozialmed Umweltmed. 2003;38:31–7.

Frankenberger M, Sternsdorf T, Pechumer H, Pforte A, Ziegler-Heitbrock HW. Differential cytokine expression in human blood monocyte subpopulations: a polymerase chain reaction analysis. Blood. 1996;87(1):373–7.CrossRefPubMed

Fröhner G. Belastbarkeit. In: Schnabel G, Harre D, Krug J, Herausgeber. Trainingslehre–Trainingswissenschaft Leistung–Training–Wettkampf. Aachen: Meyer & Meyer; 2008. S. 243–69.

Ge HY. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Curr Pain Headache Rep. 2010;14(5):339–45. https://doi.org/10.1007/s11916-010-0127-5.CrossRefPubMed

Ge HY, Nie H, Madeleine P, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009;147:233–40.CrossRefPubMed

Ge HY, Wang Y, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010;11(7):644–51. https://doi.org/10.1016/j.jpain.2009.10.006. Epub 2009 Nov 14.CrossRefPubMed

Giske L, Vøllestad NK, Mengshoel AM, Jensen J, Knardahl S, Røe C. Attenuated adrenergic responses to exercise in women with fibromyalgia – a controlled study. Eur J Pain. 2008;12(3):351–60. https://doi.org/10.1016/j.ejpain.2007.07.007. Epub 2007 Sep 10.CrossRefPubMed

Handschin C, Spiegelman BM. The role of exercise and PGC1[alpha] in inflammation and chronic disease. Nature. 2008;454:463–9.CrossRefPubMedPubMedCentral

Hummel T, Schiessl C, Wendler J, Kobal G. Peripheral and central nervous changes in patients with rheumatoid arthritis in response to repetitive painful stimulation. Int J Psychophysiol. 2000;37(2):177–83. https://doi.org/10.1016/s0167-8760(00)00087-8.CrossRefPubMed

Indo HP, Yen HC, Nakanishi I, Matsumoto K, Tamura M, Nagano Y, Matsui H, Gusev O, Cornette R, Okuda T, Minamiyama Y, Ichikawa H, Suenaga S, Oki M, Sato T, Ozawa T, Clair DK, Majima HJ. A mitochondrial superoxide theory for oxidative stress diseases and aging. J Clin Biochem Nutr. 2015;56(1):1–7. https://doi.org/10.3164/jcbn.14-42. Epub 2014 Dec 23.CrossRefPubMed

Jordan S, Hoebel J. Gesundheitskompetenz von Erwachsenen in Deutschland Ergebnisse der Studie „Gesundheit in Deutschland aktuell“ (GEDA). Bundesgesundheitsbl. 2015;58:942–50. https://doi.org/10.1007/s00103-015-2200-z. Online publiziert: 31. Juli 2015, Springer-Verlag Berlin Heidelberg; https://www.rki.de/DE/Content/GesundAZ/G/Gesundheitskompetenz/Ge-sundheitskompetenz_node.html.

Khan AN, Jacobsen HE, Khan J, Filippi CG, Levine M, Lehman RA Jr, Riew KD, Lenke LG, Chahine NO. Inflammatory biomarkers of low back pain and disc degeneration: a review. Ann N Y Acad Sci. 2017;1410(1):68–84. https://doi.org/10.1111/nyas.13551.CrossRefPubMedPubMedCentral

Klaver-Król EG, Rasker JJ, Henriquez NR, Verheijen WG, Zwarts MJ. Muscle fiber velocity and electromyographic signs of fatigue in fibromyalgia. Muscle Nerve. 2012;46(5):738–45. https://doi.org/10.1002/mus.23382.CrossRefPubMed

Kosek E, Hansson P. Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects. Pain. 1997;70(1):41–51. https://doi.org/10.1016/s0304-959(96)03295-2.CrossRefPubMed

Kosek E, Cohen M, Baron R, Gebhart GF, Mico JA, Rice AS, Rief W, Sluka AK. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016;157(7):1382–6. https://doi.org/10.1097/j.pain.0000000000000507.CrossRefPubMed

Lampa J. Pain without inflammation in rheumatic diseases. Best Pract Res Clin Rheumatol. 2019;33(3):101439. https://doi.org/10.1016/j.berh.2019.101439. Epub 2019 Sep 6.

Le Maitre CL, Hoyland JA, Freemont AJ. Catabolic cytokine expression in degenerate and herniated human intervertebral discs: IL-1 beta and TNF alpha expression profile. Arthritis Res Ther. 2007;9:R77.CrossRefPubMedPubMedCentral

Lee YC. Effect and treatment of chronic pain in inflammatory arthritis. Curr Rheumatol Rep. 2013;15(1):300. https://doi.org/10.1007/s11926-012-0300-4.CrossRefPubMedPubMedCentral

Lee YC, Nassikas NJ, Clauw DJ. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Res Ther. 2011;13(2):211. https://doi.org/10.1186/ar3306.CrossRefPubMedPubMedCentral

Leffler AS, Kosek E, Lerndal T, Nordmark B, Hansson P. Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis. Eur J Pain. 2002;6(2):161–76. https://doi.org/10.1053/eujp.2001.0313.CrossRefPubMed

Li Y, Liu J, Liu Z, Duan D. Inflammation in low back pain may be detected from the peripheral blood: suggestions for biomarker. Biosci Rep. 2016;36(4):e00361. https://doi.org/10.1042/BSR20160187. Print 2016 Aug.CrossRefPubMedPubMedCentral

Liochev SI. Reactive oxygen species and the free radical theory of aging. Free Radic Biol Med. 2013;60:1–4. https://doi.org/10.1016/j.freeradbiomed.2013.02.011. Epub 2013 Feb 19.CrossRefPubMed

López-Ruiz M, Losilla JM, Monfort J, Portell M, Gutiérrez T, Poca V, Garcia-Fructuoso F, Llorente J, Garcia-Fontanals A, Deus J. Central sensitization in knee osteoarthritis and fibromyalgia: beyond depression and anxiety. PLoS One. 2019;14(12):e0225836. https://doi.org/10.1371/journal.pone.0225836. eCollection 2019.CrossRefPubMedPubMedCentral

Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–47. https://doi.org/10.1016/S0140-6736(16)30970-9. Epub 2016 Oct 11.CrossRefPubMed

Matcham F, Galloway J, Hotopf M, Roberts E, Scott IC, Steer S, Norton S. The impact of targeted rheumatoid arthritis pharmacologic treatment on mental health: a systematic review and network meta-analysis. Arthritis Rheum. 2018;70(9):1377–91.CrossRef

Melzack R. Pain and the neuromatrix in the brain. J Dent Educ. 2001;65(12):1378–82.CrossRefPubMed

Meng T, Thayer S, Venn A, Wu F, Cicuttini F, March L, Dwyer T, Halliday A, Cross M, Laslett LL, Jones G, Ding C, Antony B. Association of childhood adiposity measures with adulthood knee cartilage defects and bone marrow lesions: a 25-year cohort study. Osteoarthr Cartil. 2018;26(8):1055–62. https://doi.org/10.1016/j.joca.2018.05.008. Epub 2018 May 25.CrossRef

Mense S. Differences between myofascial trigger points and tender points. Schmerz. 2011;25(1):93–103; quiz 104. https://doi.org/10.1007/s00482-010-0965-4.CrossRefPubMed

Negre-Salvayre A, Guerby P, Gayral S, Laffargue M, Salvayre R. Role of reactive oxygen species in atherosclerosis: Lessons from murine genetic models. Free Radic Biol Med. 2020;149:8–22. https://doi.org/10.1016/j.freeradbiomed.2019.10.011. Epub 2019 Nov 25.CrossRefPubMed

Pedersen BK. The diseasome of physical inactivity and the role of myokines in muscle-fat cross talk. J Physiol. 2009;587:5559–68.CrossRefPubMedPubMedCentral

Petersen AMW, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol. 2005;98:1154–62.CrossRefPubMed

Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord. 2017;18(1):188. https://doi.org/10.1186/s12891-017-1549-6.CrossRefPubMedPubMedCentral

Piotrowska A, Bartnik E. The role of reactive oxygen species and mitochondria in aging. Postepy Biochem. 2014;60(2):240–7.PubMed

Rifbjerg-Madsen S, Christensen AW, Christensen R, Hetland ML, Bliddal H, Kristensen LE, Danneskiold-Samsøe B, Amris K. Pain and pain mechanisms in patients with inflammatory arthritis: a Danish nationwide cross-sectional DANBIO registry survey. PLoS One. 2017;12(7):e0180014. https://doi.org/10.1371/journal.pone.0180014. eCollection 2017.CrossRefPubMedPubMedCentral

Ritz BW, Alexander GM, Nogusa S, Perreault MJ, Peterlin BL, Grothusen JR, Schwartzman RJ. Elevated blood levels of inflammatory monocytes (CD14+ CD16+ ) in patients with complex regional pain syndrome. Clin Exp Immunol. 2011;164(1):108–17. https://doi.org/10.1111/j.1365-2249.2010.04308.x. Epub 2011 Feb 8.CrossRefPubMedPubMedCentral

Sandström A, Ellerbrock I, Jensen KB, Martinsen S, Altawil R, Hakeberg P, Fransson P, Lampa J, Kosek E. Altered cerebral pain processing of noxious stimuli from inflamed joints in rheumatoid arthritis: an event-related fMRI study. Brain Behav Immun. 2019;81:272–9. https://doi.org/10.1016/j.bbi.2019.06.024. Epub 2019 Jun 19.CrossRefPubMed

Sarzi-Puttini P, Salaffi F, Di Franco M, Bazzichi L, Cassisi G, Casale R, Cazzola M, Stisi S, Battellino M, Atzeni F. Pain in rheumatoid arthritis: a critical review. Reumatismo. 2014;66(1):18–27. https://doi.org/10.4081/reumatismo.2014.760.CrossRefPubMed

Schweinhardt P, Kalk N, Wartolowska K, Chessell I, Wordsworth P, Tracey I. Investigation into the neural correlates of emotional augmentation of clinical pain. NeuroImage. 2008;40(2):759–66. https://doi.org/10.1016/j.neuroimage.2007.12.016. Epub 2007 Dec 23.CrossRefPubMed

Shang Y, Gurley K, Symons B, Long D, Srikuea R, Crofford LJ, Peterson CA, Yu G. Noninvasive optical characterization of muscle blood flow, oxygenation, and metabolism in women with fibromyalgia. Arthritis Res Ther. 2012;14(6):R236. https://doi.org/10.1186/ar4079.CrossRefPubMedPubMedCentral

Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114–29. https://doi.org/10.1016/j.neuroscience.2016.06.006. Epub 2016 Jun 9.CrossRefPubMed

Srikuea R, Symons TB, Long DE, Lee JD, Shang Y, Chomentowski PJ, Yu G, Crofford LJ, Peterson CA. Association of fibromyalgia with altered skeletal muscle characteristics which may contribute to postexertional fatigue in postmenopausal women. Arthritis Rheum. 2013;65(2):519–28. https://doi.org/10.1002/art.37763.CrossRefPubMedPubMedCentral

Staud R, Vierck CJ, Robinson ME, Price DD. Overall fibromyalgia pain is predicted by ratings of local pain and painrelated negative affect – possible role of peripheral tissues. Rheumatology. 2006;45:1409–15.CrossRefPubMed

Syrenicz A, Garanty-Bogacka B, Syrenicz M, Gebala A, Walczak M. Low-grade systemic inflammation and the risk of type 2 diabetes in obese children and adolescents. Neuro Endocrinol Lett. 2006a;27(4):453–8.PubMed

Syrenicz A, Garanty-Bogacka B, Syrenicz M, Gebala A, Dawid G, Walczak M. Relation of low-grade inflammation and endothelial activation to blood pressure in obese children and adolescents. Neuro Endocrinol Lett. 2006b;27(4):459–64.PubMed

Teodorczyk-Injeyan JA, Triano JJ, Injeyan HS. Nonspecific low back pain: inflammatory profiles of patients with acute and chronic pain. Clin J Pain. 2019;35(10):818–25. https://doi.org/10.1097/AJP.0000000000000745.CrossRefPubMedPubMedCentral

Tornero-Caballero MC, Salom-Moreno J, Cigarán-Méndez M, Morales-Cabezas M, Madeleine P, Fernández-de-Las-Peñas C. Muscle trigger points and pressure pain sensitivity maps of the feet in women with fibromyalgia syndrome. Pain Med. 2016;17(10):1923–32. https://doi.org/10.1093/pm/pnw090. Epub 2016 Jun 1.CrossRefPubMed

Veale DJ, Orr C, Fearon U. Cellular and molecular perspectives in rheumatoid arthritis. Semin Immunopathol. 2017;39(4):343–54. https://doi.org/10.1007/s00281-017-0633-1. Epub 2017 May 15.CrossRefPubMed

Wolfe F, Russell IJ, Vipraio G, Ross K, Anderson J. Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population. J Rheumatol. 1997;24(3):555–9.PubMed

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–15.CrossRefPubMed

World Health Organization. Global recommendations on physical activity for health. 1.Exercise. 2.Life style. 3.Health promotion. 4.Chronic disease – prevention and control. 5.National health programs. WHO World Health Organization: Schweiz;2011.

Wuertz K, Haglund L. Inflammatory mediators in intervertebral disk degeneration and discogenic pain. Global Spine J. 2013;3:175–84.CrossRefPubMedPubMedCentral

Titel: Schmerzen bei chronischen nicht entzündlichen und entzündlichen Erkrankungen
verfasst von: Wolfgang Laube
Verlag: Springer Berlin Heidelberg
Buch: Schmerztherapie ohne Medikamente
Print ISBN: 978-3-662-63845-3

Electronic ISBN: 978-3-662-63846-0

Copyright-Jahr: 2022
DOI: https://doi.org/10.1007/978-3-662-63846-0_2

Update AINS

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

hier abonnieren

Springer Medizin

2. Schmerzen bei chronischen nicht entzündlichen und entzündlichen Erkrankungen

Zusammenfassung

Neu im Fachgebiet AINS

Darf man die Behandlung eines Neonazis ablehnen?

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Häufigste Gründe für Brustschmerzen bei Kindern

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

Update AINS

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet AINS

Darf man die Behandlung eines Neonazis ablehnen?

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Häufigste Gründe für Brustschmerzen bei Kindern

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

Update AINS