Der Orthopäde
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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.
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Clinically relevant pain states are usually characterized as either inflammatory or neuropathic. While inflammatory pain results from tissue injury or damage, neuropathic pain results from damage or disease of nerve fibers. In either pain state, both the peripheral and the central nociceptive system contribute significantly to the generation of pain. ⋯ Central sensitization is a neuronal process that amplifies the activity from the periphery. Numerous molecular mechanisms are involved in peripheral and central nociceptive processes including rapid functional changes of signaling (increase of excitability) and long-term regulatory changes such as upregulation of mediator/receptor systems. The conscious pain is generated by thalamocortical networks that produce both sensory discriminative and affective components of the pain response.