Der Schmerz
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The objective of this survey was to investigate the current status of the epidural and intrathecal management in patients with chronic cancer and non-cancer pain in Germany and Austria. ⋯ Epidural and intrathecal pain therapy is frequently used in Germany and Austria, either as a complementary or alternative treatment to systemic pain therapy. Local anaesthetics followed by opioids are the most commonly used medicaments for this treatment. For some of the applied substances neurotoxicological data are lacking. The use of these substances has to be considered very carefully.
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We performed 52 peripheral nerve stimulation procedures since 1991. In addition to 48 patients with CRPS II, 4 patients with phantom-limb pain were treated. Incomplete or complete lesion of the stimulated peripheral nerves was determined in all patients. Surgically treatment failed in all cases. All patients had been given extensive conservative pain therapy. ⋯ Neurostimulation of peripheral nerves should be considered as an established concept to treat surgically failed peripheral nerve lesions.
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Outcome quality of medical treatment depends on structure quality of the treatment facility. In the present study we tried evaluate structural parameters of outpatient treatment facilities relating to management of headache, low back pain and cancer pain. ⋯ There are considerable structural deficits in outpatient treatment facilities involved in management of patients suffering from chronic headache, chronic back pain and cancer pain. Realisation of standards according to the "Schmerztherapievereinbarung" needs organisation of an interdisciplinary network between the different specialties necessary for pain management. Interdisciplinary cooperation should be supported by the official organization of the medical self-government in Germany--the Kassenärztliche Vereinigung--which has to assure optimal conditions for outpatient treatments.