Der Schmerz
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Treatment of chronic low back pain (CLBP) is not only expensive, but is frequently not totally effective. For these reasons, it is important that the risk factors that correlate with the development of chronic pain be considered at the early stage of acute low-back pain (ALBP) in order to implement early treatment to prevent the condition from becoming chronic. ⋯ In light of the need to contain costs, a program for the prevention of chronic back pain can only be provided for those ALBP patients with an increased risk of having CLBP. Further research on the prevention on CLBP is needed.
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Idiopathic headaches are probably the most common problem in schoolchildren. The prevalence increases up to 70% in 14-year-old adolescents, with migraines ranging from 10% to 20%. Tension headaches are often understandable on a psychosocial and behavioral basis; in migraine, however, a familial disposition of 60%-80% is well known. ⋯ It is presently unknown, whether pharmacological prophylaxis during several months followed by attack-free periods of months or years may influence the long-term prognosis. For tension headaches, transcutaneous electrical nerve stimulation (TENS) has produced good improvement in recent investigations in about 3/4 of cases; full remissions were possible in most cases. A combination of relaxation and behavioral therapy should be recommended where possible, especially in cases of therapeutic resistance.
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Most patients with very advanced cancer suffer from severe pain, and many studies have demonstrated how this pain can be sufficiently controlled. It is of great importance to find out if the findings are also true during the final stage of cancer and how the treatment must be adapted. We therefore examined the methods and efficacy of providing pain relief for dying cancer patients. ⋯ Only 4% of the patients treated in the way described experienced severe pain during the final stage of cancer. Systemic administration of drugs is very effective in relieving pain in dying patients. No signs of tolerance to opioids could be observed, even in patients who had been taking opioids for a longer period of time (average 39 days).
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A central antinociceptive effect of calcitonin has been well established in animal experiments. Owing to the lack of appropriate studies, however, a final judgement cannot be made regarding the value of calcitonin in pain therapy. Positive clinical experiences have been reported in the following cases. (1) In isolated osseous tumor pain and in pain caused by tumorous infiltration of peripheral nerve tissue or acute malignant transverse lesions of the spinal cord (with paraplegia), calcitonin can be a suitable supplement to opiate therapy. (2) In algodystrophy calcitonin can be administered in addition to physical therapy. ⋯ Dangerous side-effects have not been reported to date. However, dose-dependent side-effects occur frequently, which the patients often consider very distressing. The disadvantages and the "escape" phenomenon that occur during longterm use restrict the value of calcitonin as an analgesic.