Der Schmerz
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Different therapeutic modalities are available for the treatment of rheumatic pain. The most important one, besides physiotherapy, is medication with analgesics and adjuvant drugs. Analgesics are given orally and by a stepwise approach in keeping with the principles of cancer pain therapy. ⋯ Patients often suffer from constipation, nausea and vomiting, but these side-effects can be treated with laxatives and antiemetic drugs. There is no reason to differentiate between opioid medication in a cancer patient with pain and in a patient with "non-malignant" rheumatic pain. Centrally acting muscle relaxants may be helpful as adjuvant medication in patients with myalgia for example, and tricyclic antidepressants can also be beneficial, especially in neuropathic pain and for patients with psychiatric distress associated with pain.
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The first studies on psychological treatment of pediatric headache appeared about 10 years ago; most of them were published in Anglo-American journals. This review focuses on relaxation training and biofeedback (EMG and hand temperature feedback) as the psychological interventions most often used in pediatric migraine and tension headaches. ⋯ Biofeedback studies are methodologically less well controlled and although positive effects have been observed, e.g., in single case studies, the relative usefulness of biofeedback has yet to be determined. Deficits in research on the psychological treatment of headache in children and adolescents are described, new research issues are discussed and recommendations for more systematic research are given.
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Thirty patients suffering from reflex sympathetic dystrophy accompanied by continuous spontaneous pain of the affected distal limb were investigated. The aim of the study was to determine whether a suprasystolic compression (cuff) fixed at the distal part of the affected limb and interrupting the distal circulation would influence the pain. In most cases, this so-called ischaemia-test led to a substantial suppression of pain, which occurred during the first or second minute after the cuff had been applied. Therefore, this test can be used as a new diagnostic tool to support the clinical diagnosis of reflex sympathetic dystrophy.
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At one of the symposia at the 16th congress of the German Society for the Study of Pain in Berlin in 1991 an update on the use of pumps and ports in pain treatment was presented. This article tries to focus on some of the conclusions of this meeding. (1) To avoid neurologial damage only analgesic substances that have been tested in animals and with which we have adequate clinical experience, e.g. opiates, clonidine and baclofen, should be used for spinal anaesthesia. (2) The increasing number of manufactures of pumps, ports, catheters and puncture needles should pay more attention to safety and reliability of their products to avoid technical complications and should try to achieve compatibility between the different accessories such as catheters, needles and connecting pieces. (3) The mode of application (spinal versus epidural, pump versus port or externalized catheter) depends on the predicted period of treatment (spinal application for long-term treatment requires more hygienic precautions) and on differences in the individual care of the patient (4). Spinal opiates for benign pain (in case of failure of less invasive pain regiments) have been tested successfully, but the follow-up is not yet long enough to allow recommendation of this therapy for general use. (5) Local anaesthetics are useful for short-term use. The addition of local anaesthetics for continuous low-flow infusion of opiates requires further comparative studies. (6) Spinal baclofen is effective against pain induced by muscle spasms but not against non-spasticity-related pain syndrome.