Der Orthopäde
-
Minimally invasive injection therapy is an effective approach for the treatment of sciatica with less complications. This therapy is a sufficient option in cases without absolute indications for operation. The paper describes in detail the different injection techniques like spinal nerve analgesia, epidural dorsal/perineural injections, vertebral joint infiltrations, and radiculographies.
-
The specific minimal-invasive injection therapy is a key-procedure for cervical spine syndromes when performing a multimodal pain-therapy. Due to the exactly placed injections pain can be overcome. ⋯ The complex injection technique affords knowledge and expertise. The exact application and the specific complications are presented in detail.
-
The pharmacotherapy of musculoskeletal pain remains of high importance in Western countries. The present review concentrates on the use of acidic (nonsteroidal anti-inflammatory drugs) and nonacidic (paracetamol, selective cyclooxygenase-2 inhibitors) antipyretic analgesics in the therapy of musculoskeletal pain disorders with particular emphasis on the diverse pharmacokinetic properties and unwanted side effects of these substances.
-
Organized orthopaedic pain management is a major part of successful patient treatment. Therefore pain management should start before surgery. Patients need to be informed about the operation and the subsequent procedures. ⋯ Supportive treatment approaches such as cryotherapy or transcutaneous electrical nerve stimulation (TENS) are useful in the post-operative period. Physiotherapy after surgery should be extended stepwise regarding the operative device and it is of particular importance to respect pain intensities. The post-hospital regimen for a continuous pain medication should be given to the orthopaedic specialist.
-
The orthopedist can choose from three classes of drugs to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAID) possess sufficient analgetic efficacy, but they are hampered by often causing gastrointestinal pain and bleeding. Opioids are strong analgetics that can be successfully used against strong pain. ⋯ Because of the risk of damage to white blood cells leading to agranulocytosis with foudroyant infections their use should be strictly limited to conditions that justify such a risk like tumor or colic pain. The aniline derivative acetaminophen (= paracetamol) is well tolerated and is the drug of choice in usual common pain. Large doses are to be avoided because of liver damage, especially in children.