Der Schmerz
-
According to WHO guidelines, morphine is the first choice for the treatment of chronic cancer pain, preferably as a controlled-release preparation administered orally. The WHO classifies the quality of pain management of a particular country by its morphine consumption for medical reasons. For this article, data from clinical and market research were collected. ⋯ The report also focuses on physicians' subjective viewpoints and prejudices. When strong opioids are only rarely prescribed, a general practitioner then has difficulties in assessing pain and possible side effects and treatment evaluation. Clinical research, too, is hampered by special regulations concerning controlled opioid administration.
-
The present legal requirements for the prescription of controlled drugs remains an impediment to adequate therapy for chronic pain because of an abundance of legal regulations. The physician prescribing opioids must consider the permitted maximum amount per prescription, the period of time the drug is prescribed for, numerous cross references, and other special regulations, and he still cannot be sure that he does not violate certain legal requirements. Often these difficulties result in withholding necessary pain treatment. ⋯ It is important that the use of the narcotic be justified in the sense of paragraph 13 Abs. 1 of the drug control regulation, as judged by the responsible prescriber of the drug, and that any offence be punished. The use of triplicate prescriptions guarantees sufficient proof. Legislation is requested that will substitute for the present drug control regulations, which are difficult to handle.
-
There is a great need to expand current knowledge of the various functional capacity measurements used in the rehabilitation of chronic low back pain (CLBP) patients. The literature on these patients reports that mobility, endurance, trunk strength and lifting capacity decrease during the process of chronicity. Chronically disabled patients appear to have lower functional capacity than asymptomatic persons. ⋯ Study results showed that physical capacity in disabled patients with low back pain is substantially reduced in comparison to persons who do not suffer from back pain. The only exception was in trunk flexor strength and endurance, in which measurements did not differ between the patients and the control group. However, even CLBP- patients with long-term pain and severe physical illness can successfully improve their physical condition by participating in an active treatment program. Back extensor muscle training has to be included in physical therapy. Because of loss of condition during the time after treatment, regular monitoring of patients and their home training programs is necessary. Overall, treatment of CLBP has to include physical training and psychosocial treatment to achieve satisfactory results.