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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There are no data available from representative samples of the general German population on predictors of widespread pain (WP) and fibromyalgia syndrome (FMS). ⋯ WP and FMS are components of a complex of high somatic symptom intensity, low social class index and older age.
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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.
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Chronic pain patients using opioids frequently suffer from constipation which compromises well-being. Such an opioid-induced gastro-intestinal complication can occur regularly in patients in palliative care as well as in analgesic sedated intensive care patients or during prolonged perioperative pain therapy. Discomfort and distress in the affected patients can be so severely pronounced that they would rather suffer from the pain than from the side effect of constipation. ⋯ An interference with central analgesia does not occur as the molecules cannot pass the blood-brain barrier due to their charged states. A reduction of opioid therapy or the development of withdrawal symptoms can be avoided. Studies have shown that methylnaltrexone is not only safe and efficient for chronically constipated palliative care patients but offers promising therapeutic options for further patient collectives.
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The German Society for the Study of Pain (DGSS) commissioned a meta-analytic review of the evidence on the long-term effects of opioids, non-opioid analgesics and cognitive- behavioral procedures for chronic non-cancer pain. A multidisciplinary expert panel was established to review the evidence and formulate recommendations as far as possible on the basis of means, standard deviations and group sizes from randomized controlled trials. ⋯ Therefore, the LONTS guidelines focus on the prevention of adverse effects and misuse and a multidisciplinary approach for the treatment of chronic pain is strongly recommended. Principles of opioid prescription and on the management of risks associated with the long-term use of opioids are described.