Der Schmerz
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Postherpetic neuralgia can lead to therapy-resistant neuropathic pain. We report the case of a 74-year-old woman with postherpetic perineal neuralgia resistant to opioids and antiepileptic drugs who has been successfully treated with oral ketamine for 28 months. ⋯ Significant side effects have not yet been reported. Despite "off-label" use, ketamine is an important third line option in cases of therapy-resistant neuropathic pain.
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We observed a patient with incomplete, cervical paraplegia and opioid-induced constipation who developed a resistance to laxatives after 15 years of treatment. The constipation-induced reduction in the patient's quality of life was improved using 12 mg methylnaltrexone, a peripheral mu-opioid receptor antagonist, administered subcutaneously twice a week.
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Most people would like to spend the end of their life at home in their familiar surroundings. Is it possible to look after and care for people at home if the work of doctors, carers and hospices is coordinated and comprehensive? ⋯ Our results indicate that by introducing a specialized structure for outpatient palliative care, including a specialized 24-h palliative medical service, an improvement in total care for patients at the end of their lives can be achieved.
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The aim of this study was to investigate the criterion validity of the Mainz Pain Staging System (MPSS), considering the four axes of the MPSS separately. ⋯ Findings confirm the criterion validity of the MPSS for chronic low back pain. In addition, results support the significance of psychosocial factors for the further development of chronicity.