Der Schmerz
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In 60 women undergoing vaginal hysterectomy, a total of 420 pain evaluations of postoperative pain intensity were performed by an observer and the patients. Pain intensity was rated by the observer on a visual analogue scale. The patients themselves evaluated their pain on a visual analogue scale and on a 101-point numerical rating scale. ⋯ The correlation between patients' self-assessments and observers' ratings was poor (r (2)=0.28;y=0.66x+31.3). There was also no clear correlation between pain intensity and heart rate or arterial blood pressure. A reliable assessment of pain intensity can only be performed by patients' self-assessment and not by observers' ratings.
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Thirty patients suffering from reflex sympathetic dystrophy accompanied by continuous spontaneous pain of the affected distal limb were investigated. The aim of the study was to determine whether a suprasystolic compression (cuff) fixed at the distal part of the affected limb and interrupting the distal circulation would influence the pain. In most cases, this so-called ischaemia-test led to a substantial suppression of pain, which occurred during the first or second minute after the cuff had been applied. Therefore, this test can be used as a new diagnostic tool to support the clinical diagnosis of reflex sympathetic dystrophy.
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The first studies on psychological treatment of pediatric headache appeared about 10 years ago; most of them were published in Anglo-American journals. This review focuses on relaxation training and biofeedback (EMG and hand temperature feedback) as the psychological interventions most often used in pediatric migraine and tension headaches. ⋯ Biofeedback studies are methodologically less well controlled and although positive effects have been observed, e.g., in single case studies, the relative usefulness of biofeedback has yet to be determined. Deficits in research on the psychological treatment of headache in children and adolescents are described, new research issues are discussed and recommendations for more systematic research are given.
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Back and leg pain in patients with lumbar disc herniation can be caused by various mechanisms. In addition to nerve root compression, functional alterations in the sacroiliac joint, facet joint or the iliolumbar and sacrotuberal ligaments can produce "pseudoradicular" lower back syndrome. The following study attempts to show whether or not pain and functional alterations in the sacroiliac joint (SIJ) correlate with herniations revealed by computed tomography (CT). ⋯ Frequency of SIJ tenderness is significantly higher in patients with herniations between L5 and S1. Since the SIJ is innervated by the r. dorsalis of the sacral roots, the increased tenderness can be explained by the change in neurovegetative innervation of the SIJ. Due to the high correlation between lumbar disc herniation and SIJ dysfunction, disc herniation should be considered as a possible cause of sacroiliac-joint syndrome.
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At one of the symposia at the 16th congress of the German Society for the Study of Pain in Berlin in 1991 an update on the use of pumps and ports in pain treatment was presented. This article tries to focus on some of the conclusions of this meeding. (1) To avoid neurologial damage only analgesic substances that have been tested in animals and with which we have adequate clinical experience, e.g. opiates, clonidine and baclofen, should be used for spinal anaesthesia. (2) The increasing number of manufactures of pumps, ports, catheters and puncture needles should pay more attention to safety and reliability of their products to avoid technical complications and should try to achieve compatibility between the different accessories such as catheters, needles and connecting pieces. (3) The mode of application (spinal versus epidural, pump versus port or externalized catheter) depends on the predicted period of treatment (spinal application for long-term treatment requires more hygienic precautions) and on differences in the individual care of the patient (4). Spinal opiates for benign pain (in case of failure of less invasive pain regiments) have been tested successfully, but the follow-up is not yet long enough to allow recommendation of this therapy for general use. (5) Local anaesthetics are useful for short-term use. The addition of local anaesthetics for continuous low-flow infusion of opiates requires further comparative studies. (6) Spinal baclofen is effective against pain induced by muscle spasms but not against non-spasticity-related pain syndrome.