Der Schmerz
-
Review Comparative Study
[Gender differences in acute and chronic pain conditions : Implications for diagnosis and therapy.]
Gender differences can influence incidence and outcome of acute and chronic pain conditions. The reasons are to be found in genetic factors, hormonal effects and differences in anatomy and physiology. Furthermore differences relating to psychiatric comorbidities (i.e. depression) and psychosocial factors (roles, coping strategies) have been demonstrated. ⋯ There is a gender bias in diagnosis and therapy. There is a need to study the influence of gender, age and race in order to optimize treatment towards a more individualized therapy. This article highlights already identified differences.
-
Comparative Study
[Quality and appropriateness of pain medication : Instrument for estimation in nursing home residents.]
The pain medication appropriateness scale (PMASD) was developed in 2006 in the USA to evaluate the quality and appropriateness of pain treatment in nursing home residents (NHR). This tool can be used to identify potential problems with the pharmacological treatment of pain. ⋯ An appropriate tool for quantitative evaluation of pain treatment was so far not available in Germany. The PMASD analysis showed deficits of pain management in NHR. This tool showed good practicability in Germany and could provide a valuable tool for pain treatment in clinical research and practice.
-
Burnout is not a medical diagnosis but a developmental aberration which is associated with the risk of subsequent mental and somatic diseases. It can be summarized under a fatigue process with stress symptoms, societal-linked stressors and a driving force stress intensifier. In the mental stress circle, burnout presents as an accelerated vicious spiral driven by high demands. ⋯ Burnout is also a meaning of life crisis, triggered by the narrowing of performance and success. The anthropological therapeutic approach targets an enhancement of self-conception and lifestyle. Other available therapy approaches for burnout include pharmacotherapy, coaching, management consulting and inpatient treatment.
-
Opioids are an essential part of cancer pain management but particularly in this patient group physicians could misinterpret opioid-induced potentially life-threatening side effects within the central nervous system (CNS) or hyperalgesia as a consequence of tumor progression. In this case increasing the opioid dose or switching to rapidly acting opioids may trigger a vicious circle. We describe a case report of a male patient who was treated with high doses of transdermal and endonasal fentanyl 2 years after pancreatomy due to cancer. ⋯ Further diagnostics revealed multiple incisional hernia as the reason of the pain syndrome. The patient recovered after herniotomy and has now been pain free without any pain medication for more than 16 months. This case report underlines again the necessity of pain diagnostics also in assumed palliative patients with the risks of high dose opioid treatment.