MMW Fortschritte der Medizin
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For the treatment of back pain, behavioral modification, pharmacotherapy, non-pharmacological conservative treatment and surgical procedures are available. Systemic and metabolic disorders require specific treatment. Medication that may be considered includes non-opioid analgesics with or without an antiphlogistic action, opioid analgesics, muscle relaxants and antidepressants. ⋯ For myofascial pain, flupirtine is to be recommended because of its analgetic and muscle-tone-normalizing actions. Local anesthetic infiltration or nerve blocks are useful in blocking nociception with its pathophysiological sequelae. For chronic back pain, opioids and some antidepressants have a more favorable benefit-risk profile than NSAIDs.
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The relationship between family doctor and patient is usually one of mutual trust developed over many years. This is why a patient with cancer most likely first raise the question of a second opinion with him, in particular in a "palliative situation". ⋯ Only then can the family doctor, as the closest and most trusted medical carer who is well acquainted with the patient's overall situation, help the patient to obtain a well-founded second opinion. In so doing they can also additional benefit the patient by sparing him many a fruitless odyssey, dashed false hopes and great disappointments.
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Dizziness is a common symptom that, despite extensive medical evaluation, often remains unexplained. Psychiatric or psychosomatic disorders underlie the condition in 30-55% of the cases. ⋯ The assessment of psychiatric and psychosomatic symptoms should always be included in the neuro-otological examination of dizziness. Early interdisciplinary treatment should be initiated with the aim of preventing chronification of psycho-genetic vertigo.