Der Schmerz
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A multidisciplinary approach, acknowledged as being the best treatment strategy for a wide range of chronic pain patients, requires cooperation at least between trained professionals in the medical and the psychological disciplines. Psychological criteria are formulated to bridge persisting gaps in the interdisciplinary implementation of pain treatment strategies.
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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.