Der Schmerz
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Oral baclofen, the most often prescribed antispastic drug, has been shown to be effective in trigeminal neuralgia. Spinal application of baclofen leads to a complete supression of spasticity even in cases in which no previous oral antispastic medication achieved a response. ⋯ Spinal baclofen has also been effective during long-term infusion with an implanted pump for more than 1 year. Spinal baclofen infusion seems to be a possibility in the treatment of severe trigeminal neuralgia resistant to other forms of therapy.
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The chronic headache patients in our neurological outpatient department treated between 1985 and 1987 were retrospectively studied. One-third (n=44) were examined and questioned about the efficacy of treatment. Initial treatment in the outpatient department had been at least 2 years before the study, thus allowing evaluation of the long-term course of the illness. ⋯ Adequate consideration of the non-medical therapeutic elements should be ensured in such structures headache therapy. A uniform classification of headache and records of the course in the form of headache diaries are essential for comparing the results. A sufficiantly long post-therapy observation period should be allowed in order to facilitate evaluation of the therapeutic response.
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The rationale for the use of spinal cord stimulation (SCS) in the treatment of chronic pain arose from Melzack and Wall's gate theory of the control of pain (1965). Originally electrodes were placed directly on the spinal cord via open operation, while now they are placed by means of direct puncture the epidural space. ⋯ The implantation of an SCS system is a surgical procedure, which requires the highest standards in asepsis. The operation and its complications and ways of avoiding them are described.
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The paper reports the results of a population-based pain survey in Lübeck, a city of 210,000 inhabitants in the northern part of Germany. Data were collected from 308 respondents (systematic sample aged 26-75 years) by mailed questionnaires (response rate: 80%). Subjects indicated on a list of 11 pain conditions whether they suffered from these kinds of painever, during the past 6 months, or "today". ⋯ However, 8% of the total sample reported more than 14 pain-related disability days and were classified as being affected by pain to a sociomedically relevant degree. Approximately half of the subjects who reported pain in the past 6 months did not consult a physician. This proportion decreased considerably in subgroups with more than 6 disability days.