Der Schmerz
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For the provision of home care for dying patients the availability of potent pain medication is essential. The aim of this survey directed at community palliative care physicians was to assess and evaluate the current situation of provision and supply of pain medication in the community palliative care setting, including hospices and specialised palliative care teams. ⋯ Despite the fact that the need for unrestricted opioid provision in specialised community palliative care is indisputable and recognised, the implementation is nevertheless hindered by a multitude of legal red tape. One solution to the problem would be the legalisation of emergency supplies of narcotics to be held by specialised facilities, such as hospices or specialised palliative care teams. This could, for instance, be implemented via the narcotics requisition form currently used for inpatient supplies in hospitals or for emergency services. Hospices and care homes must be enabled to receive their supplies directly without bureaucratic hindrance and without the need for renewed narcotic prescription.
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Functional brain imaging techniques allow to noninvasively visualize neuronal activity and associated metabolic consequences. In combination with elegant experimental paradigms in both healthy volunteers and, increasingly, in patients, functional brain imaging has led to a vast accumulation of knowledge concerning the CNS mechanisms involved in pain perception and pain modulation in humans. The so-called "pain matrix" represents a dynamic network of cortical and subcortical brain regions regularly activated by acute pain. ⋯ This system includes cingulo-frontal brain areas together with specific brainstem nuclei that can exert control over nociceptive input at the level of the dorsal horn of the spinal cord. Recent studies support the view that a dysfunctional interaction between the ascending and descending pain system may contribute to the development or maintenance of chronic pain states. Here we provide an overview of the principles, applications, key findings and recent advances of functional imaging in pain research.
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The term "peripheral neuropathic pain syndromes" summarizes several chronic pain syndromes, which can occur focally or generalized in the peripheral nervous system in the course of an impairment of afferent neurons. Controlled clinical trials gave distinct indications for systemic treatments with antidepressants, anticonvulsants and opioid analgesics in several neuropathic pain syndromes. In addition to these systemic therapies, there are also two topical treatment options: topical application of lidocaine and capsaicin. ⋯ In the context of a partial nerve lesion that leaves behind partially preserved or regenerated afferent nerve fibres, just these channels could be used as target structures for topical medications. Topically applied drugs are absorbed systemically only in minute quantities, so systemic side effects are negligible. Pharmacological interactions with systematically acting substances are also virtually absent; thus, topically applied substances are especially appropriate for add-on therapy in addition to systemic pain medication.