Der Schmerz
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Multidisciplinary treatment of patients with chronic pain in pain centers was studied. The conditions of all multidisciplinary pain centers in the German federal state of Northrhine-Westphalia (NRW), an area of about 17 million inhabitants, were investigated. ⋯ There is an existing network of multidisciplinary pain centers in Northrhine-Westphalia. If we consider the estimated number of 850,000 patients with chronic pain in this area, the low number of yearly treated patients (120,000) indicates, that the capacity of multidisciplinary pain centers is inadequate for the demand of multidisciplinary treatment of patients with chronic pain in Northrhine-Westphalia.
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The use of transdermal fentanyl is gaining in importance in the management of cancer pain. We describe the reasons for switching opioid medication to transdermal fentanyl in a pain management unit. ⋯ Conversion to transdermal therapy may readjust the balance between opioid analgesia and side effects. The opioid switch resulted in more pain relief or fewer side effects in half of the patients. A proposed equianalgesic conversion ratio between 70:1 and 100:1 from oral slow-release morphine to transdermal fentanyl can be confirmed by our data. Conversion rates from other opioids to transdermal fentanyl are suggested.
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Many causes are given as the main reason for inadequate pain therapy. The objective of our study was to demonstrate the current position of doctors in general practice all over Austria who prescribe prescriptions. ⋯ Based on the data at hand, pain therapy for patients should be excellent. The reality, however, is somewhat different. The large number of doctors who did not reply makes it enormously difficult to make a statement about the position of pain therapy in Austria.
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In patients with renal or hepatic failure, the pharmacokinetics of opioids may be affected in several ways, leading to the necessity to correct the dose. The liver is the major site for biotransformation of most opioids. The major metabolic pathway is oxidation. ⋯ On the other hand, the analgesic activity of codeine and tilidine depends on transformation into the active metabolites, morphine and nortilidine. In the case of reduced metabolism in chronic liver disease, the analgesic action of these drugs may be compromised. Lastly, the disposition of a few opioids, such as fentanyl, sufentanil, and remifentanil, appears to be unaffected in liver disease.
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The objective of this survey was to investigate the current status of the epidural and intrathecal management in patients with chronic cancer and non-cancer pain in Germany and Austria. ⋯ Epidural and intrathecal pain therapy is frequently used in Germany and Austria, either as a complementary or alternative treatment to systemic pain therapy. Local anaesthetics followed by opioids are the most commonly used medicaments for this treatment. For some of the applied substances neurotoxicological data are lacking. The use of these substances has to be considered very carefully.