Der Schmerz
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In the widely used German pain questionnaire, qualitative pain characteristics are assessed by the Schmerzbeschreibungsliste (SBL). In clinical practice these adjectives insufficiently cover the spectrum of orofacial pain perceptions (OFP) and have not been proven by data. The aim of this study was the analysis of a questionnaire focussing on OFP (ZZM-FB) in which nine additional pain descriptors were amended to the SBL (SBL-OF). ⋯ In this cohort, some ADD descriptors were selected more frequently than some SBL items, indicating that the SBL does not adequately capture the characteristics of OFP. These results will be considered in the construction of a revised ZZM-FB, which is currently in development.
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Serotonin syndrome is a dangerous and rare complication of a pharmacotherapy and can lead to death. Caused by unwanted interactions of serotonergic drugs, it is characterised by a neuroexcitatory triad of mental changes, neuromuscular hyperactivity and autonomic instability. Opioids with serotonergic effects include the phenylpiperidine series opioids fentanyl, methadone, meperidine and tramadol and the morphine analogues oxycodone and codeine. ⋯ Higher risk combinations (e.g. monoamine oxidase inhibitors with tramadol) must be avoided. Treatment with serotonergic agents must be stopped in moderate or severe serotonin syndrome. Patients with a severe serotonin syndrome require symptomatic intensive care and specifically a pharmacological antagonism with cyproheptadine or chlorpromazine.
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Bisphosphonates (BP) are used in the treatment of severe osteoporosis and metastasis of malignant diseases. A possible relationship between the occurrence of osteonecrosis of the jaw and BP therapy was first described in 2003. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is difficult to treat. In some cases the condition of the patients is so compromised that only minimally invasive surgery is possible. Histopathologically, osteonecrosis shows the features of chronic sequestered osteomyelitis, which can be found in different areas of the upper and lower jaw. Sometimes extensive resections of the jaw are necessary. Thus, BRONJ can cause mutilation, impairment of function and esthetics in the orofacial system and, thereby, compromise the life quality of the patients. Triggering factors are often tooth extraction without surgical plastic wound closure of the alveoli, but can also be associated with bruises from denture or other minor wounds. ⋯ Because of the complex symptoms, close cooperation between oncologists, dentists, and maxillofacial surgeons is required in the treatment of BRONJ. Before starting therapy with bisphosphonates and during the therapy, dental treatment and monitoring of the patient' oral health is necessary.
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In recent decades there has been much work on cognitive behavioral approaches to chronic pain. Now there is a considerable variety of concepts and interventions which share the same roots but differ in theoretical issues and application. ⋯ The latter have been influencing therapy and theory in recent years. The cognitive behavioral perspective on chronic pain has, therefore, not only become more differentiated and complex but also more complicated.