Der Schmerz
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Multicenter Study Comparative Study Controlled Clinical Trial
[Evaluation of the "initiative pain-free clinic" for quality improvement in postoperative pain management. A prospective controlled study].
Demonstration of improved postoperative pain management by implementation of the S3 guidelines on treatment of acute perioperative and posttraumatic pain, by the integrated quality management concept "quality management acute pain" of the TÜV Rheinland or by participation in the benchmark project "Quality improvement in postoperative pain management" (QUIPS). ⋯ The main objective of the certification concept quality management acute pain as a tool for the successful implementation of the S3 guidelines on treatment of acute perioperative and posttraumatic pain, led to a significant improvement in patient outcome. Participation in QUIPS is an ideal supplement to TÜV Rheinland certification and can be recommended as a benchmarking tool to evaluate outcome.
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Randomized Controlled Trial Multicenter Study
[Botulinum toxin type A in the prophylactic treatment of chronic migraine].
Since the second edition of the International classification of headache disorders (ICDH-II 2004), chronic migraine has been listed amongst migraine complications. Compared to episodic migraine the prevalence of chronic migraine is low, its impact, however, significant. Until recently no prophylactic drug had been approved for chronic migraine prophylaxis. ⋯ Thus, for the first time a prophylactic drug against chronic migraine is available which is both effective and well tolerated. Botox® has been licensed in England for the prophylaxis of headaches in adults with chronic migraine in 2010. Approval for its use in Germany has been applied for.
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Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. ⋯ In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.
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Besides the responses to nociceptive stimuli other neural function modes of the brain are necessary to obtain a comprehensive understanding of pain processing in humans. During a resting state without extrinsic stimulation the human brain generates spontaneous low frequency fluctuations of neural activity. This intrinsic activity does not reflect random background noise but is highly organized in several networks. Based on the findings of recent functional imaging studies, the role of these resting state networks in acute and chronic pain is discussed.
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Review Practice Guideline
[Epidural spinal cord stimulation for therapy of chronic pain. Summary of the S3 guidelines].
Epidural spinal cord stimulation (SCS) is a reversible but invasive procedure which should be used for neuropathic pain, e.g. complex regional pain syndrome I (CRPS) and for mostly chronic radiculopathy in connection with failed back surgery syndrome following unsuccessful conservative therapy. Epidural SCS can also successfully be used after exclusion of curative procedures and conservative therapy attempts for vascular-linked pain, such as in peripheral arterial occlusive disease stages II and III according to Fontaine and refractory angina pectoris. ⋯ Epidural SCS should always be used within an interdisciplinary multimodal therapy concept. Implementation should only be carried out in experienced therapy centers which are in a position to deal with potential complications.