Der Schmerz
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Thirty patients who had undergone elective anterolateral thoracotomy were studied in the surgical intensive care unit to compare the analgesic effectiveness of i.v. self-administered buprenorphine (group A) with that of epidural administration (group B) and of s.c. administration by a nurse of 0.3 mg buprenorphine every 3-4 h (group C, controls). Every 2 h the patients were asked to record their subjektive pain level as a percentage on an analogue scale: zero was to be used for no pain and 100% for the most severe pain they could imagine. the mean of all analogue scores for pain in the first 36 h was 19.4+/-3.1 for group A; 18.4+/-2.3 for group B and 42.0+/-7.4 for group C (P<0.025). When the mean scores were referred to time, it seemed that groups A and B suffered a little more pain immediately after the operation; however, after 4 h the mean scores for these groups were far lower than that for the control group. ⋯ Nurses should be instructed to provide analgesic medication on demand. Epidural administration of buprenorphine is superior to self-administration in terms of the amount of drugs used and the dosing intervals. In the quality of analgesia epidural administration and self-administration are equal and superior to the control procedure.
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Many studies have demonstrated that cancer pain can be relieved in most cases by suitable analgesic medication. Patients with a diagnosis of "intractable cancer pain", however, are referred to our pain clinic nearly every day. A retrospective study of 1140 patients was therefore performed to evaluate the pain mechanisms and whether analgesic pretreatment had been adequate. ⋯ The principal causes for the inadequacy of the analgesic pretreatment were: failure to prescribe analgesics (10% of the patients), irregular intake schedule or prolonged intervals between applications (66%), underdosage of nonopioid analgesics (27%) or opioids (42%), and withholding of nonopioid analgesics (30%), strong opioids (14%), or co-analgesic drugs (17%), although their prescription was indicated. The severe pain was thus caused in many patients by simple mistakes in the prescription of analgesics. Terms like "intractable" should be used with caution when referring to cancer pain because they are often unreflected and can make patients and physicians feel helpless or insecure.