Der Schmerz
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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.
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Within clinical practice fibromyalgia is diagnosed according to the classification criteria of the American College of Rheumatology. The examination of the tender points is still to be standardized. By using additional diagnostic criteria fibromyalgia changes into a polysymptomatic syndrom with multiple functional and psychic symptoms. ⋯ Patient education, medical training therapy, physical therapy (heat or cold) and relaxation therapy are recommended. There is a moderate evidence for the effectiveness of tricyclic antidepressants and aerobic training. The effectiveness of multicomponent therapy in fibromyalgia is still to be demonstrated.
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Currently it is unclear whether functional somatic syndromes can be explained by one common underlying functional syndrome. In any case it does not seem justified to view functional somatic syndromes as purely psychological disorders (somatized anxiety or depression). Psychiatric comorbidity and life time stress including traumatisations are mainly, but not exclusively responsible for triggering health care utilisation. ⋯ The predominance of female patients can be due to gender specific illness behaviour as well as to estrogen-induced changes in pain sensitivity. In sum, functional somatic syndromes currently are best explained by a biopsychosocial model of predisposing, triggering and maintaining factors. More research is needed particularly to clarify the role of genetic and of cultural factors.