Der Schmerz
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In a medline search (covering 1966 to Sept. 1996) 32 clinical studies were identified, in which the efficacy of paracetamol or matamizol per se, or in comparison to other analgesics, in various chronic pain states, such as migraine, dysmenorrhoea, arthritis and osteoarthritis pain and cancer pain had been examined. In patients with migraine (4 studies) several other analgesics (ibuprofen, mefenamic acid, flupirtin) were slightly more effective than paracetamol, however, the efficacy of paracetamol itself had not been assessed. In patients with chronic tension headache (1 study) paracetamol was superior to placebo, but less effective than naproxen. ⋯ Paracetamol and/or metamizol have been included in 14 studies on cancer pain, most of these studies attempting to validate the WHO analgesic ladder for cancer pain treatment. However, except for one study, in which metamizol was comparable in efficacy to morphine, all other publications do not provide detailed information on the efficacy of individual analgesics. Therefore it is not possible at present, to assess the possible merits of paracetamol or metamizol in the treatment of cancer pain from published studies.
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Pain perception is a complex psychosomatic phenomenon and is influenced by different psychological variables. Apart from their pain perception, chronic pain patients also suffer from different bodily complaints. The clinical significance of this finding is not yet clear. Bodily complaints in chronic pain patients may represent (a) a bodily expression of depressive symptoms, (b) a sign of chronicity, and (c) the expression of a heightened bodily awareness in the sense of hypochondriasis. ⋯ From a cognitive-behavioral perspective the results support the hypothesis that psychological disturbance in chronic pain is a cause of long-standing pain perception and the result of the chronification process.
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The idea of using Ketamine to treat chronic pain is mainly based on the central antinoceptive effect of the substance acting as a noncompetitive antagonist at the NMDA-receptor. In the present meta analysis over a period from 1/1981 up to 6/1996 twelve publications (1994-1996), which have dealt the use of Ketamine for patients with chronic pain, are evaluated and discussed. The entire positive evaluation of the drug is based on the results of the studies under consideration. ⋯ Here, the therapy had to break off in two cases. In nine cases the side effects could be suppressed by Droperidol. For the future, research with more study power is necessary to establish Ketamine in the therapy of chronic pain.
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Postoperative nausea and vomiting remains an important problem. Many risk factors have been identified; however, the importance of postoperative analgesic technique and patient expectation remain poorly defined. ⋯ Study results show that patient expectation is a potent predictor of postoperative nausea, a risk factor hitherto ignored in the anaesthetic literature, and that, in the provision of analgesia following major surgery, epidural analgesia is associated with less PONV than intravenous morphine.
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Two methods for the assessment of change are evaluated: (1) subjects' ratings of the outcome taken after termination of the treatment, and (2) comparison of test scores taken before the beginning and after termination of the treatment. ⋯ It is concluded that, contrary to the formulation of the items, the ORS scale does not so much assess change, but rather depicts the state of the subjects at the time the assessment is made.