Der Schmerz
-
Randomized Controlled Trial
[Modulation of cortical pain processing by cyclooxygenase inhibition: a functional MRI study].
Little is known about changes in brain activity with pharmacological modulation of hyperalgesia. Therefore, we sought to investigate the cerebral processing of hyperalgesia and acute pain using functional magnetic resonance imaging (fMRI) and pharmacological modulation with cyclooxygenase (COX) inhibitors. ⋯ This study provides new evidence for the involvement of COX inhibitors in modulating the cerebral activity associated with acute pain and hyperalgesia. Our results hint at a differential modulation of brain areas under either analgesia or antihyperalgesia.
-
Older patients, particularly those with multimorbidity, complain about many symptoms which also occur under analgesics (especially with opioids). The goals of the study were to quantify symptoms and discuss the relationships to analgesics, pain, multimorbidity, function, age and gender. ⋯ Our results underline the difficult interpretation of symptoms as a side-effect of analgesic treatment in older patients. Pain and gender differences have to be considered. The recommendation to carefully record symptoms before analgesic treatment is supported by our results.
-
Criterion-related validity of the Mainz Pain Staging System (MPSS) was examined. ⋯ The results support criterion validity of the MPSS, however, they also corroborate the concept that identification of medium and high grade pain by the MPSS has to be followed by a psychological diagnostic assessment. By this stepwise diagnostic process, therapy aims and treatment regimens can be designed more adequately.
-
The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. ⋯ At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family. If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care.