Der Anaesthesist
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Even if the effectiveness of psychotherapy emphasising a cognitive behavioral approach is clearly shown by randomised controlled trials, it is difficult to motivate chronic pain patients to use this type of treatment. We compared the effectiveness of consultation and liaison models of co-operation between an outpatient pain clinic and a psychosomatic department in creating motivation to psychotherapy. ⋯ The liaison model of co-operation was significantly more effective to enhance physician's and patient's motivation for a psychosomatic approach to pain treatment. Psychotherapy is better accepted by patients suffering from chronic pain if it is offered in a multidisciplinary context and in the familiar surroundings of the pain clinic.
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We describe a case of postoperative subdural dislocation (between dura and arachnoidea spinalis) of an epidural catheter. After 24 h of normal functioning of the catheter, the injection of 5 ml lidocaine caused an extensive unilateral sensory block including the cranial nerves. ⋯ The safety of patients can only be guaranteed if epidural catheters are managed solely by professional anaesthesiological personnel. Anatomy, mechanisms of complications and clinical differential diagnosis are discussed.