Der Schmerz
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Despite its importance for chronic pain diseases, pain-related disability is a poorly defined concept with theoretical deficits. The distinction between impairment, disability, and handicap proposed by the WHO is an important contribution to clarification of the disability construct. With reference to four criteria (underlying disability construct, degree of behaviour generalization, assessment mode, scope) different assessment procedures of pain-related disability are presented and the advantages and disadvantages of each are discussed. ⋯ The results from four data sets concerning different aspects of reliability and validity confirm the good psychometric properties of the instrument. The instrument can be used in chronic pain research as well as in clinical contexts. It is recommended that subjective disability data be complemented by behavioral observation and additional data sources (e.g. assessment of disability by the spouse/partner).
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For diagnosis of the pain origin in reflex sympathetic dystrophy (RSD), sympathetic blocks, including the intravenous regional guanethidine (IVRG) block after Hannington-Kiff, are recommended. Since the results obtained with this kind of block are sometimes unsatisfactory, modifications were made to increase its technical efficacy. ⋯ The modified IVRG block seems to have a high diagnostic value with respect to the presence of a sympathetic contribution to the pain in RSD. As a reduced GA dose/block is used, this form of the block appears to be safer than other kinds of sympathetic blocks.
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An interdisciplinary working group on cancer pain was founded by the German Association for the Study of Pain in 1991. The goal of this group is the development and dissemination of training and information material, guidelines and curricula in the fields of cancer pain, palliative medicine and the legal regulations for the prescription of opioids. ⋯ The results of this survey clarify the need for concrete guidelines in cancer pain management which are at the same time readily understandable. The new edition of 40 000 copies of the "Abbreviated Guidelines for Cancer Pain Management" was published in October 1993. Because of the good response, a further booklet on "Cancer Pain Management in Children" is being planned.
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Pain relief in children during the perioperative period can be provided by means of peripherally or centrally acting analgesics or of regional anaesthetic techniques. Narcotics or regional blockde are indicated when peripherally acting analgesics prove inadequate to abolish pain. Side effects of narcotics must be taken into account: opioids must not be administered unless continuous safety monitoring of the child's respiration is assured. ⋯ All advantages and drawbacks of the various techniques that might be appropriate must be considered: the technique involving the least risk and side effects is the anaesthetic technique with a broad margin of safety when applied by an anaesthesiologist who has experience with paediatric regional blocks include topical anaesthesia, local infiltration, peripheral nerve blocks (e.g. nervi dorsalis penis, plexus axillaris) and caudal epidural blockade. Caution must be exercised whenever narcotics are administered systemically or epidurally; side effects must not be underestimated, even under conditions of intensive care observation. The provision of effective pain relief is a rewarding task-and particularly in little children.
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There have been major advances in knowledge and efficient techniques for pain relief have been developed during recent years. Nevertheless, many patients on surgical wards still suffer from severe pain following surgery or trauma. Therefore, in the University hospital of Kiel (Germany) an anaesthesiology-based acute pain service (APS) was established in 1985 to improve this situation.