Der Schmerz
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Until recently the measurement of pain in cognitively impaired patients represented a neglected field in the diagnostics and treatment of pain. Investigations indicate a prevalence of pain in nursing home residents of between 45 % and 80 %. ⋯ The Doloshort scale is a well suited measurement instrument for the evaluation of pain in cognitively impaired patients. Because of the short form only simple instructions are necessary and it has a high acceptance with users.
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Comparative Study
[Treatment of elderly with chronic pain in geriatric care and pain therapy facilities in Germany : Survey results].
Even though there are no satisfactory data available on the prevalence of chronic pain in the elderly, it is certainly a common problem in Germany. The goal of this study is to provide information on the treatment of elderly patients with chronic pain in geriatric care and pain therapy facilities in Germany. ⋯ Due to the differences between geriatric and pain management departments shown in all investigated areas, an exchange between these two cross-sectional subjects could help to improve inpatient, outpatient and intersectoral treatment of elderly patients with chronic pain.
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Opioids are increasingly used in the elderly. Side effects differ compared to other analgesics. ⋯ The indication for opioid therapy should be narrow. The patient and their caregivers must be provided patient information regarding opioid therapy. The principle "start low, go slow" is highly recommended. To reduce the risk of falls, longer acting opioids should be used and short acting opioids should be avoided. Everyday relevant negative effects on cognition are possible in opioid use and have to be observed. As recommended in the recently published German guideline for long-term use of opioids in noncancer pain a critical check after 3 months and in case of dosing over 120 mg morphine equivalents is advisable, especially for older patients. Liver and kidney function and drug interactions have to be taken into consideration like in every age group.
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Randomized Controlled Trial Comparative Study
[Efficacy of epidural steroid injections for chronic lumbar pain syndromes without neurological deficits : A randomized, double blind study as part of a multimodal treatment concept].
Chronic lumbar pain syndromes without neurological deficits are generated by a multitude of causes. Functional, morphological and psychosocial factors are discussed. In many cases a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. For this study it was postulated that a diseased disc results in a local inflammatory reaction therefore causing pain and impairing treatability of patients. An epidural injection of steroids can reduce inflammation and therefore improve treatability and ultimately treatment outcome. ⋯ After the epidural injection the decrease in pain and increase in treatability was statistically significant. The mechanism of the improvement is not clear and should be examined further. The epidural injection of a steroid in this subgroup of patients did not lead to a clinical improvement in the outcome.