Der Schmerz
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Only limited data and experience with patient-controlled analgesia (PCA) in outpatients for palliative home care, related to organization, effectiveness and costs are available. ⋯ In cases of cancer pain patients with failed oral or transcutaneous opioid medication, sufficient pain reduction can be achieved with parenteral drug administration by PCA. Domestic PCA requires a lot of human and financial resources, with trained nursing services and regular house visits by physicians experienced in palliative medicine but this method is sufficient and safe to use.
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The philosophical discussion of the phenomenon of pain can help to increase the understanding of human beings in pain and to accompany them in such an experience. Pain affects a human being who has a body. The "I" of this human being cannot escape into painlessness. ⋯ The pain shows how the experience of being in a body is connected to the experience of having an identity. Pain reduces the ability to act and narrows the possibility to interact with others; it affects the manner how the human is still or no longer able to address himself to others. In the reduction of his existence a human being experiences a basic condition of his existence: He is vulnerable.
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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.
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Review
[Chronic migraine and headache by medication overuse. Evolution and revision of classification].
The first International classification of headache disorders (ICHD-I) described migraine as a recurring headache disorder manifesting in attacks lasting 4-72 h. The headache frequency was not considered in these first diagnostic criteria of migraine. Thus, a chronic migraine with at least 15 migraine days per month was only included in the ICHD-II in 2004. ⋯ The term transformed migraine describes the transformation of an episodic migraine into a chronic one, whether medication overuse had been present or not. Up till now a widely accepted definition of chronic migraine and medication overuse headache has not been established due to different views. An overview of the evolution of the diagnostic criteria for both headache disorders in recent years is provided.
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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.