Der Schmerz
-
The case of a 78-year-old patient with cancer-related pain and additionally mixed-pain syndrome is presented. Pain therapy with buprenorphine TTS 210 microg/h every 3 days was sufficient in the beginning, later the therapy was changed because of increasing problems of tape fixing during fever periods under chemotherapy to a continuous infusion of buprenorphine intravenously via an external medication pump. During the course of therapy it became necessary to increase the dose to 99.9 mg/day buprenorphine. ⋯ At the same time the patient was vigilant and cooperative without signs of intoxication until the end of life at home in the presence of his family. If no signs of intoxication occur under extreme opioid therapy and a sufficient pain therapy can be achieved, a rotation to another opioid is not necessary. However, outpatient palliative care requires a frequent adaptation to the individually varying opioid demand of the patient and time-consuming nursing care.
-
Pain-related disability affects many children and adolescents suffering from chronic pain and may exert an impact on all areas of their lives. Reduction of pain-related disability is, therefore, a fundamental aim of treatment; however, no validated means exist to assess pain-related disability in children and adolescents. The aim of this study was to translate the Pediatric Pain Disability Index (P-PDI) of Varni into German and to investigate its psychometric qualities. ⋯ There is now a validated German version of the P-PDI to measure pain-related disability in adolescents suffering from chronic pain, which can be used in studies investigating treatment effectiveness.
-
The multimodal therapy has proved to be useful for the treatment of patients with chronic back pain. The aim of this methodical study was to test whether specific effects for the individual can be inferred from general effects of the entire sample, in order to define criteria for the success of treatment. These could be helpful when deciding to which patients the multimodal therapy can best be applied. ⋯ Taking into account principles of classical test theory this study showed that sufficient systematic coherence of the data must be proven before changes can be calculated. As long as neither an adequate systematic nor useful criteria can be found, there seems to be no reason to exclude any patient from multimodal therapy using pre-selection criteria.
-
Data on the efficacy of the Dachau multidisciplinary treatment program for chronic pain is presented. The treatment is administered in a primary care day clinic and the treatment period is 5 weeks plus 5 booster days 6 months later. The program is characterized by high treatment intensity (122.5 h over 5 weeks) and is aimed at patients where outpatient pain therapy proved to be insufficient. The treatment plan is applicable to different types of chronic pain and the main treatment objective is functional restoration. ⋯ The Dachau multidisciplinary treatment for chronic pain achieved significant improvements which remained stable for 6 months after treatment.
-
In order to match the interindividual and intraindividual differences in opioid requirements of pediatric oncology patients with mucositis, patient-controlled analgesia (PCA) seems to be the optimal pain therapy option, but scientific data are lacking. ⋯ PCA seems to be an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose in children with chemotherapy-induced mucositis. This is expressed through the increase in daily self-administered opioid doses after starting PCA, the huge interindividual variability in opioid consumption and the rare event of an un-delivered bolus request during lock-out time. With the use of a background infusion, additional bolus requests are rare during the night.