Praxis
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Opioids have been accepted as appropriate analgesic treatment for pain associated with cancer. However, controversy exists about their use for chronic noncancer pain. ⋯ Nevertheless, pain management of chronic severe pain with opioids can be the only help when alternative methods are too risky of fail to be effective. This article briefly reviews the published literature on this topic and discusses some practical guidelines for the use of opioids in the treatment of non-cancer pain.
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Pain, particularly chronic pain, arises from the interaction of multiple simultaneously operating physiologic processes. The current understanding of the anatomy and physiology of pain is limited to a characterization of pathways and does not explain why a particular stimulus is felt as pain of a particular kind and intensity. In this article, we trace the afferent pain pathways from periphery (reception) to center (perception), i.e., from peripheral nerve, through the spinal cord and brain stem, to the thalamus and cerebral cortex. A number of neurosurgical procedures for the treatment of pain are discussed, and their anatomic basis is explained.
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Under the provisions of the Health Insurance Law (KVG), the costs of preventive medicine are to be borne by the mandatory health insurance. Although it has been defined who shall be responsible for taking the necessary measures, concrete objectives have yet to be established. ⋯ The author discusses basic questions relating to this situation: The nature of the preventive measures (GENOME Analysis), and the economic efficiency. An insight is also given into the work of the Preventive Medicine Services Subcommittee of the Federal Service-Providing Committee (Subkommission Präventive Leistungen der Eidgenössischen Leistungskommission) and the criteria adopted.
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In the Intensive Care Unit important decisions in critically ill and often incompetent patients have to be made within a short period of time and without all the necessary information. Two main questions arise: 1. How can the autonomy of the patients be respected under these circumstances? 2. Which diagnostic and therapeutic activities are adequate and reasonable in each individual patient? An optimal communication between the people involved helps to find the best answers.