Der Schmerz
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The Working Group on Neuromodulation of the German Association for the Study of Pain, composed of representatives from various scientific specialty societies, met on December 9, 2000, March 24, 2001, October 5, 2001, and December 8, 2001. As a result of these discussions grounded in current knowledge, the following guidelines were formulated for the standardization of invasive techniques of neuromodulation intended to serve as a systematic aid in decision-making and to provide recommendations for practice-oriented methods. The guidelines were based on both the clinical and practical experience of the group participants (see information box on the next page) as well as on the current scientific literature and guidance from the consensus report of the European Federation of IASP Chapters (EFIC) [23]. ⋯ The guidelines will be revised should new scientific results become available, at the latest in 2 years. The plan exists to further develop the guidelines to stages II and III (AWMF). The Steering Committee of the DGSS appraised the guidelines and authorized the guidelines before publication.
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The intrathecal application of opioids is promoted as a safe and cost-efficient method to treat chronic pain of nonmalignant origin. But the way of application could trigger the appearance of otherwise rare side-effects. One of those side-effects could be the alteration of androgen hormones. Can a long-time-application of intrathecal opioids result in gynecomastia? ⋯ Further research is needed to support the clinical suspicion of a correlation between intrathecal opioids and gynecomastia. In case of a opioid-produced gynecomastia tests of the oestrogen-testosterone-ratio should be performed. An early substitution of testosterone could prevent a full fledged gynecomastia.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[Preemptive randomized, double-blind study with lornoxicam in gynecological surgery].
Lornoxicam is a non opioid analgesic belonging to the oxicam group. The aim of this study was to determine whether lornoxicam has a preemptive analgesic effect. ⋯ Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and lead to reduced consumption of opioid analgesics postoperatively in patients undergoing gynecological operations.
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Trigeminal neuralgia and postherpetic neuralgia are the most relevant neuralgiform facial pain syndromes. Trigeminal neuralgia is characterized by lancinating intensive pain attacks of very short duration, triggered by external cues,whereas postherpetic neuralgia consists predominantly of long-lasting burning pain. ⋯ Other pain syndromes described encompass the Tolosa-Hunt-syndrome, cervicogenic headache, craniomandibular dysfunction syndrome, atypical facial pain and rarer syndromes. Therapeutic recommendations are based on evidence based medicine criteria (EBM).
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Pain specialists are often involved in assessing social medical aspects of chronic pain patients. A standardized examination in the assessment process is not published. Data and statements on the assessment process between 1993 and 1997 were recorded from 15 experts by questionnaire. ⋯ It contains a recommendation of a standardized process with minimal criteria and an optional supplement of the standardized process with problematical patients (e.g.demonstration, aggravation, simulation). Minimal demands on a qualified assessment of chronic pain patients should contain the study of the history, the German Pain-Questionnaire, the analysis of all the painful complaints with weighting their importance, the examination and the basic registration of sensational, emotional, cognitive, behavioral and social aspects of the chronic pain syndrome. An appended glossary of the most usable psychological tests with comments on their validation criteria aims to provide a more standard multimodal assessment of chronic pain patients complaints and functionability.