Der Schmerz
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PCAO (patient-controlled analgesia in outpatients) is a new treatment concept designed to overcome chronic or acute pain of cancer patients. From 1989 to 1992, a total of with tumour pain 204 patients were treated in the pain clinics of Fürth in cooperation with the Department of Radiation at the University Hospital in Regensburg. In 90 of these patients adequate oral medication was impossible because of problems in swallowing or blockage of the gastrointestinal tract, and subcutaneous opioid infusion over 24 h was therefore instituted. ⋯ PCAO for treatment of cancer patients at home yields freedom from of pain around the clock, independence, and quality of life with active personal involvement. The most important thing is that the patient can sleep during the night, as can the doctor, the nurse and relatives, as they do not need to give injections during the night. This new method of treating the pain of cancer patients at home in advanced disease is also well accepted by social security authorities, as it reduces the costs dramatically.
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Animal experiments have unequivocally demonstrated peripheral antinociceptive effects of opioids in inflamed tissue. Exogenous mu-, delta- und kappa-agonists can produce such effects. Opioid receptors are present on peripheral terminals of primary afferent neurons and their endogenous ligands are produced and contained in resident immune cells within the inflamed tissue. ⋯ A small number of clinical studies has examined the peripheral analgesic effects of opioids. Their results are equivocal so far. In view of the predominant role of the inflammatory process in the manifestation of peripheral opioid effects, the postoperative situation seems to be particularly worthwhile to study.
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Postoperative pain arises largely from distension and sectioning of nerve fibers, which generate a short-lasting but enormous afferent impulse barrage. This causes a long-lasting enlargement of receptive fields and an increase in excitability of dorsal horn neurons sending their axons up to the brain. ⋯ Prostaglandins in the spinal cord facilitate the synaptic transmission from nociceptive afferents. Nonsteroidal anti-inflammatory drugs (NSAIDs) produce relief from postoperative pain by blocking the formation of prostaglandins in the spinal cord, thus abolishing the facilitatory effect of these compounds.