Der Schmerz
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Overuse of any kind of headache drugs may lead to the development of the medication overuse headache (MOH). Clinical features of MOH depend on the substance class that has been overused. Overuse of analgesics leads to a chronic tension-type like headache, the overuse of triptans to daily migraine-like headache or to the increase of migraine frequency. ⋯ Treatment includes withdrawal followed by structured acute therapy and initiation of specific prophylactic treatment for the underlying primary headache. The relapse rate after a successful withdrawal is about 30%. Predictors for relapse are tension-type headache and the overuse of analgesics in combination with codeine, caffeine or opioids.
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Actual recommendations for treatment of migraine consist both of pharmacological and non-pharmacological treatment. The latter enables the patient higher responsibility and self-efficacy in coping with migraine. Therefore, the active involvement in the treatment of the patients is obligatory in all psychological pain therapy methods. ⋯ The long-term effects are comparable with those of pharmacological treatment, combination of pharmacological and non-pharmacological treatment lead to even higher efficacy and is often indicated. In case of headache in children, behavioural therapy should be the method of first choice. In the text, empirically proven methods of psychological pain therapy in migraine will be explained.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative analgesia with rofecoxib. How effective is the preoperative application of a 25 mg dose?].
The purpose of this study was to evaluate the analgesic efficacy of 25 mg rofecoxib. ⋯ Preoperative application of 25 mg rofecoxib is not effective for postoperative analgesia in patients after minor trauma surgery.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Reduction of chronic pain for non-postherpetic peripheral neuropathies after topical treatment with a lidocaine patch].
To clarify whether the therapeutic indication for a lidocaine patch to treat postherpetic neuralgia can be extended to include other focal peripheral neuropathic pain syndromes, we performed a subgroup analysis of a placebo-controlled, double-blind randomized study. ⋯ As an adjuvant medication, the lidocaine patch is effective and safe for reducing chronic pain and physical complaints in focal non-herpetic neuropathies.
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Review
[Cannabinoids in the treatment of the cachexia-anorexia syndrome in palliative care patients].
Loss of appetite and cachexia are frequent symptoms in palliative care patients. However, therapeutic regimens often prove ineffective, and the quality of life of many patients is significantly impaired by these symptoms. Causes and pathophysiology of anorexia and cachexia are complex and must be identified and treated. ⋯ In cancer patients, cannabinoids proved more effective than placebo but less than gestagenes. Compared to placebo, higher efficacy of cannabinoids could be demonstrated in patients with AIDS as well as in patients with Morbus Alzheimer. However, side effects, such as dizziness, tiredness and daze led to discontinuation of the cannabinoid therapy in some patients.