Der Schmerz
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Pertinent guidelines recommend opioid-type analgesics for management of severe pain. However, in the past, opioids were prescribed for only a minority of these patients. In this representative study we examined the prevalence of cancer patients with and without opioid prescription in their final year of life in 1993 and 1996 in Bremen, Northern Germany. ⋯ The prescription prevalence of opioids remains low among cancer patients in their final year of life. However, our study provides some evidence for positive developments with respect to prescription times and dosage between 1993 and 1996. These changes are likely due to a limited subgroup of practioners.
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Clinical and experimental studies suggest that a generalized style of hypervigilant information processing may influence the pathogenesis of fibromyalgia (FM). This article deals with the question whether perception and processing of sensory stimuli in patients suffering from FM can be described in terms of "generalized hypervigilance". ⋯ On the whole the existing studies argue against the assumption of trait-like hypervigilant information processing in FM-patients. A more appropriate explanation of the results is in terms of the interaction of situational and personal factors.
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In this study three instruments measuring disability of patients with low-back pain are presented and evaluated: (1) the Behinderungsfragebogen (RM) - a German version of the Roland & Morris disability questionnaire (RDQ) (2) a numerical rating scale measuring disability in general and (2) eight numerical rating scales measuring specific dimensions of disability (standing, sitting, walking, driving a car, carrying light loads, carrying heavy loads, sleeping, and sexual intercourse). ⋯ The RM is an instrument measuring patients' perception of their disability that offers simple, fast practicability for patients and tester. The 2 rating scales: The 8 numerical rating scales measuring specific dimensions of disability (QL3) offer all the advantages of the numerical rating scale measuring disability in general (QL1) (simple instruction, high plausibility for the patients, and simple, fast practicability), but they provide more information about the patient's disability, which allows comparisons of disability at different times in the therapeutic process. Numerical rating scales are not suitable for patients with poor ability to abstract. For these patients it is necessary to use a questionnaire which asks concretely about what the patient can or cannot do (e. g. RM). Because of its better psychometric properties, the QL3 should be favored over the RM.
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In chronic pain patient's diagnostic and therapy planning many complex information must be evaluated and analysed. The variety of data cannot be mastered without assistance of a database tool adapted to these special need. ⋯ Due to its ability of export into other databases and already enclosed routines QUAST permits an internal assurance of quality of process and outcome in pain management. It also can be an instrument of an external quality assurance. QUAST is at present the only computer system available in Germany, to fulfil the required prerequisites for adequate quality control.