Therapeutische Umschau. Revue thérapeutique
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For drug therapy a differentiation of acute and chronic pain is essential. In emergency situations of acute abdominal pain a fast diagnosis is mandatory. Analgesia should be provided as soon as possible. ⋯ Co-analgesics like anticonvulsants and antidepressants are utilized to reduce sensitization and improve the endogenous pain modulating system. Non drug approaches and alternative treatment options might be useful. In contrast, orally or transcutaneously administered opioids are the principal corner stone for the treatment of cancer pain.
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Abdominal pain is a frequent symptom among elderly hospitalized patients. Taking the patient's history is often difficult because of a cognitive impairment. ⋯ Especially atypical and less symptomatic courses render establishing the correct diagnosis more difficult. The higher comorbidity, the often more advanced disease stage at the time of seeking medical attention and an delayed accurate diagnosis all contribute to the higher mortality in the elderly patients.
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Delirium may be induced by a variety of reasons, among them drugs and in particular the combination of drugs. In elderly people a delirium is often misinterpreted as dementia. Anticholinergic activity is the mode of action by which drugs cause delirium. ⋯ In addition some opioids have anticholinergic effects. Other drugs may induce delirium by dehydration (loop diuretics like furosemide) or sedation (benzodiazapines like lorazepam). Elderly people are at especially high risk to develop delirium, because of the multitude of drugs often prescribed to them, because they tend to drink to little, and because their brain is more sensitive to psychoactive drugs.
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Chronic pruritus may be induced by drugs. In this, chronic pruritus must be differentiated from acute pruritus. ⋯ Chronic pruritus, however, forms a major challenge in diagnostic and therapeutic respect. In view of the demographic development of the population and the frequent polypharmacy especially in the elderly, drugs should always be considered as a possible cause for pruritus.
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Despite the fact that the appearance of fever is related to certain diseases, in general medical practice there are still no good and reliable parameters to specify the underlying cause of fever. There is still a lot of insecurity regarding urgency, necessity, duration and form of treatment for many diseases because of the lack of reliable markers. Biomarkers like Procalcitonin, IL-6 and IL-8 show first solutions but there are still many unanswered questions.