Der Schmerz
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Following the new IHS classification, cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) are included in the classification as trigeminal autonomic cephalgias (TAC). The similarities of these syndromes suggest a considerable shared pathophysiology. These syndromes have in common that they involve activation of trigeminovascular nociceptive pathways with reflex cranial autonomic activation. ⋯ Some types of trigeminal autonomic headaches such as paroxysmal hemicrania and hemicrania continua have, unlike cluster headaches, a very robust response to indomethacin, leading to a consideration of indomethacin-sensitive headaches. This review covers the clinical picture and therapeutic options. Although studies following the criteria of evidence-based medicine (EBM) are rare, most patients can be treated sufficiently.
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In cancer pain therapy treatment with strong opioids is essential. However, it may be accompanied by the occurrence of various adverse effects. The most frequent and persistent side effect in the course of opioid treatment is constipation. ⋯ Present research indicates that there is a relation between type of opioid and degree of constipation, i.e. treatment with transdermal fentanyl or methadone tends to cause less constipation compared to morphine or hydromorphone. The route of administration of morphine--oral vs. subcutaneous--does not seem to affect the incidence of opioid-induced constipation. Furthermore, prophylaxis and efficient control of opioid-induced constipation still fail to be part of the routine in pain treatment.
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Conflicting or ambivalent findings on the effectiveness of body acupuncture in pain treatment are often attributed to flaws in study methodology. The paper describes the methodology used for the German Acupuncture Trials (gerac), which demonstrates that it is possible to design acupuncture studies in accordance with the standards of good clinical practice. ⋯ The gerac trials prove that it is possible to design and carry out acupuncture studies in accordance to stringent standards of methodology and clinical practice. The results will form a basis for the assessment of acupuncture effectiveness in Germany and abroad.
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Case Reports
[Treatment of extreme tumour pain with morphine and s-ketamine A case report of an 11-year old girl].
We are reporting on the case of an 11-year old girl with a malignant tumour. The extreme pain throughout the body could not be treated by conventional methods. By intravenous application of a morphine and s-ketamine mixture we were able to achieve a very effective analgesic result. ⋯ The latter suppresses central sensitisation and chronic pain and reduces or even prevents the development of opioid tolerance. It was possible to use smaller opiate doses more effectively, thus reducing the side effects of the pain therapy. Under associated whole-body thermochemotherapy the girl experienced general pain relief and we were able to return to conventional therapy with a fentanyl plaster.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Topical application of local anesthetics and opioids after elective tooth extraction].
The aim of this study was to provide evidence for the peripheral effect of opioids in oromaxillary procedures and to investigate whether postoperative morphine sulfate plus lidocaine administered as a local spray achieve better analgesic efficacy than lidocaine applied alone. The double-blind randomized study included 60 patients. The patients exhibited neither preoperative pain nor inflammation (tooth extractions) and when pain occurred received as alternative medication diclofenac retard 50 mg or tramadol. ⋯ No differences between the two groups were observed in the demographic data, visual and numeric analog scale in the first 24 h, or in the consumption of analgesics. Since the patients presented in a pain-free state at the time of surgery, apparently no activation of the peripheral opioid receptors occurs. Thus, a peripheral effect of opioids could not be demonstrated in this model.