Der Schmerz
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Chronic pain patients using opioids frequently suffer from constipation which compromises well-being. Such an opioid-induced gastro-intestinal complication can occur regularly in patients in palliative care as well as in analgesic sedated intensive care patients or during prolonged perioperative pain therapy. Discomfort and distress in the affected patients can be so severely pronounced that they would rather suffer from the pain than from the side effect of constipation. ⋯ An interference with central analgesia does not occur as the molecules cannot pass the blood-brain barrier due to their charged states. A reduction of opioid therapy or the development of withdrawal symptoms can be avoided. Studies have shown that methylnaltrexone is not only safe and efficient for chronically constipated palliative care patients but offers promising therapeutic options for further patient collectives.
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Data on the incidence and intensity of phantom limb pain (PLP) and phantom limb sensations (PLS) were collected in a nationwide survey. ⋯ To our knowledge the present study constitutes the largest field survey on phantom limb pain carried out in Europe and corroborates the high prevalence and intensity of PLP, unusual PLS and amputation-related sleep disturbances. The significance and manageability of phantom feelings and its risk factors need further research.
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The German Society for the Study of Pain (DGSS) commissioned a meta-analytic review of the evidence on the long-term effects of opioids, non-opioid analgesics and cognitive- behavioral procedures for chronic non-cancer pain. A multidisciplinary expert panel was established to review the evidence and formulate recommendations as far as possible on the basis of means, standard deviations and group sizes from randomized controlled trials. ⋯ Therefore, the LONTS guidelines focus on the prevention of adverse effects and misuse and a multidisciplinary approach for the treatment of chronic pain is strongly recommended. Principles of opioid prescription and on the management of risks associated with the long-term use of opioids are described.
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This survey focussed on chronic postoperative pain and impairment of quality of life after living donor nephrectomy. ⋯ Measures have to be taken to prevent chronic postoperative pain and donors should be encouraged to express their pain to ensure an adequate pain therapy.