Der Schmerz
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A review of studies on migraine therapy shows a large heterogeneity in the clinical evaluation of different drugs and behavioral approaches. The percentages of efficacy of beta-blockers or behavior therapy (relaxation, biofeedback) range from 30% to 80%. Methodological differences from one author to another in the design and conduct of the studies might be causes of this variation. ⋯ Double-blind and placebo-controlled studies are often required, but this demand often cannot be niet in empirical reality because of the individuality of the patient or the heterogeneity of the symptoms. We discuss some alternative approaches that could be used in empirical research on headache therapy. The application of single-case experiments as well as methods of time-series analysis are described as a more appropriate approach to the evaluation of studies on chronic headaches.
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Acute postoperative pain has an important psychological component. This psychological element could be registered by observing or measuring interindividual differences in pain experience, expressions of pain, and pain-coping behavior. Emotions such as anxiety, anger, and helplessness accompany postoperative pain, and postoperative pain can also be elicited by very intense preoperative anxiety. ⋯ Psychological factors also influence pain reduction. Postoperative aggression and its underlying metabolism facilitates recovery if the physicians or nurses can cope with the anger of the patient. Providing sensory descriptions of the pain during the preoperative visit and careful attention to both the pain-experiencing and the pain-free patient help to reduce pain or prevent its escalation.
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Subcutaneous self-administration of morphine with a "pain pen", a semiautomatic mechanical injection system about the size of a penholder, was tested in nine patients with severe chronic pain of malignant origin. During a period of treatment of 12-100 days (on an outpatient basis in three patients) side-effects of subcutaneous morphine could only be observed during a short-lasting initial period of adaptation. ⋯ There were no hygienic problems, and the patients learned the technique of self-injection within a few days. This system may be especially suitable for patients with gastrointestinal incompatibility of oral opiate preparations, e.g. patients with multiple drug intake.