Der Schmerz
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Special aspects of pain in children are pointed out, and the range of relevant conditions and their frequency are compared with adult pain problems. Headache and especially migraine, with incidences of up to 50% and 10%, respectively, are the most common painful conditions to be treated in the pediatric age group. Many less frequent chronic painful disorders claim the need of special, mostly neuropediatric, knowledge; optimal diagnostic precision is important for good therapeutic results. ⋯ Another problem is that of pain assessment in infants and children; some new diagnostic tools, such as color scales and the Smiley analog scale, can help to solve these specific difficulties. Furthermore, the prediatrician accepts responsibility for the patients' future as adults and is therefore involved in the early prophylaxis of analgesic abuse. The actual and future work of pediatric pain clinics, the conditions in such institutions and the philosophy behind them are presented, and the necessity for research is pointed out.
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In Western industrial countries, low back pain is one of the most frequent causes of illness. Between the 4th and 5th decades of life approximately 80% of adults complain of low back pain, lasting for fairly long periods. About 10% of this population must undergo disc surgery once during life. ⋯ CT control examinations showed clear regression in the extent of disc herniation in 15 patients, in 18 a moderate decrease, and in 9 cases the CT findings had not changed. A favorable tendency towards regression was observed in disc herniations at the level of L5-S1 and in cases showing sequestration of the disc. Herniations of the disc at higher levels between L4-5 and L3-4 or a lateral herniation, reaching the intervertebral foramen, showed on unfavorable prognosis.
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Systemic application of analgesics is still the most frequently used method of postoperative relief of pain. However, neither intermittent intramuscular nor intermittent intravenous application can provide the patient with a continuous level of analgesia. Lipid-soluble analgesics or those with polar binding that are rapidly metabolized demonstrate an rapid effectiveness. ⋯ After an initial bolus injection, the continuous infusion of an analgesic is guaranteed and may be completed by the patient with several bolus injections. PCA requires careful monitoring. We suggest that a special analgesia team to take care of the patient in special analgesia units might be appropriate in the future.
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We evaluated the efficiency of sublingual buprenorphine (Temgesic((R)) sublingual, Boehringer Mannheim GmbH) in a controlled study over a minimum of 4 weeks in 15 patients with extreme cancer pain. The tumors included 8 locoregional carcinoma recurrences in the head and neck region, 4 distant metastases of primary squamous cell carcinoma in the oral and maxillo-facial region, 1 tumor after irradiation, 1 non-Hodgkin's lymphoma, and 1 primarily non-operable carcinoma. Pain intensity was continually documented by means of a visual analogue scale (VAS) by the patients themselves. In 14 of 15 the patients it was possible to reduce pain rapidly to one fifth the original intensity with a comparatively low dosage of 0.60 mg buprenorphine (median) daily.