Der Orthopäde
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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.
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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.