Der Schmerz
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Chronic pain results in structural and functional changes of the brain. However, most of the neurophysiologic and imaging studies have been conducted with small sample sizes, some have been reproduced, but studies on larger populations are lacking. Larger epidemiologic studies are currently being performed to show specific structural changes due to chronic pain. ⋯ Most methods are very complex, which hampers their application in daily practice. But it is not only the complexity of methods, but also a lack of interaction between researchers and practitioners to formulate joint research topics and targets. This article tries to fill the gap between the practicing pain therapist and the researcher in summarizing neurophysiological and imaging results on neuropathic and chronic pain in a clear and simple manner.
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In 2009 palliative medicine was integrated into the undergraduate curriculum as cross-disciplinary subject 13 and is now part of mandatory education in German medical faculties (MF). Surveys across German MFs have shown an inhomogeneous development of this cross-disciplinary subject. The aim of this study was to assess the current state and the needs in terms of assessments in the cross-disciplinary subject 13 at German MFs. ⋯ The major form of assessment in palliative care is still a written examination, especially multiple choice tests. This format is considered to be of limited value for assessing communicative competencies and attitudes in palliative medical care. Further steps should include the development of a competence-based assessment that is also feasible for smaller MFs with limited resources.
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Constipation is a common complication in patients with opioid therapy. Additionally, patient-related risk factors also contribute to the development of constipation and these factors have to be integrated into an individualized treatment plan. ⋯ The incidence of constipation in this population remains high although a relevant number of patients were intermittently free of symptoms without using laxatives. An individualized therapy plan and patient education seem to be important elements to control opioid-associated constipation.
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The number of cases of orthopedic surgery is still increasing and postoperative pain management is of great importance for the patients. Therefore, in this study factors influencing the pain and the developement of pain in general in the first 7 days after total knee arthroplasty were examined. ⋯ The results show that there were no factors which have a significant influence on the degree of postoperative pain. Female patients suffered from more pain than males. There was an increase in pain after postoperative day 4 which might be the effect of more extensive mobilization and reduced effects of regional anesthesia. It is important that pain is treated in the early postoperative period.
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Observational Study
[Relevance of preoperative anxiety for postoperative outcome in urological surgery patients : A prospective observational study].
Preoperative anxiety is not systematically assessed during premedication appointments, although it may influence the postoperative course and outcome. ⋯ Preoperative anxiety is a frequent concern and often not correctly assessed by physicians. The use of scoring systems to detect preoperative anxiety is useful in clinical routine and helps to decide on therapeutic interventions.