Der Schmerz
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Intraspinal drug infusion using implantable pumps and catheter systems is a safe and effective therapy for selected pain patients with severe chronic pain. It improves pain relief, reduces drug-related side effects, decreases the need for oral analgesia and enhances quality of life in a segment of chronic pain patients whose pain has not been controlled with more conservative therapies. ⋯ Careful patient selection and management as well as a multidisciplinary approach are determinants of successful treatment. Current practices for patient selection and management, screening, drug selection, dosing and implantation for intrathecal drug delivery systems are discussed.
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Up to now, only an English version of the Chronic Pain Acceptance Questionnaire (CPAQ) has been available for measuring the acceptance of chronic pain. This paper presents and analyzes a German adaptation of this instrument. ⋯ The German CPAQ scale is a useful German-language instrument for the measurement of acceptance and shows good psychometric properties. The study confirms that acceptance is not an expression of a physiologically based indolence.
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This case report describes a 63-year-old male patient with considerably impaired postoperative wound healing in the region of the lower extremities. After initial drug therapy for the pain was ineffectual, the patient was treated repeatedly through an epidural catheter. ⋯ After taking into consideration the patient's age and the risk factors present as well as inclusion of the subspecialties involved for an interdisciplinary assessment, the patient was successfully treated with a conservative approach. Our contribution concludes with a detailed discussion and comparison of the literature.
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In the home-care setting, cancer pain patients in need of parenteral analgesia have to be switched to patient-controlled analgesia using portable pumps. But there is a paucity on data on the logistic requirements or the success rate of such a cost-intensive therapy performed by specialized home-care services. ⋯ If the indications are correct, intravenous PCA for palliative cancer pain patients results in higher opioid consumption and better pain control. Home-care PCA requires a lot of human and financial resources, but pain-related hospitalization can be prevented.
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Provision of sufficient post-operative pain therapy is an obligation in the clinical management of patients. A wide range of medical, technical and organizational options is used to improve post-operative pain management in orthopaedic surgery. ⋯ Additional procedures like patient-controlled analgesia or local catheter for pain are necessary for individualized or operation-specific pain therapy. The balanced combination in postoperative pain therapy could reduce side effects and complication rates, increase mobility and enhance patient satisfaction.