Therapeutische Umschau. Revue thérapeutique
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Adequate control of postoperative pain does not only improve patient satisfaction, but is also indicated from a medical point of view. Besides conventional non-opioid analgesics and opioids, more sophisticated analgesia concepts like intravenous patient-controlled analgesia (PCA) and epidural analgesia may be indicated. ⋯ In conclusion, there is good evidence of improved analgesia from PCA and epidural analgesia. Data on outcome improvement by analgesia is still contradictory, but improvement of patient satisfaction is without doubt.
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Approximately 80% of all patients with chronic pain report current or past psychological impairment. That is why psychologists or psychosomatic specialists necessarily have to play a role in pain management. ⋯ A lot of different therapeutic approaches are used in clinical practice. Today the best evidence exists for relaxation techniques, behavioural therapy and analytical psychotherapy.
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International headache classification systems presently differentiate between more than 150 types of headaches and facial pain. This paper subdivides the most frequent types of pain according to the duration of typical manifestations. ⋯ In most of these clinical pictures, the diagnosis has to be established on the basis of a carefully evaluated case history. Indications for additional technical examinations are critically assessed.
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Back pain is a common disease causing tremendous costs for treatment, work loss and pension payments. The reasons of back pain vary considerably and often remain doubtful. ⋯ Active treatment procedures should be preferred. In chronic pain patients only multimodal concepts of treatment seem to be successful as far as they take care of somatic, psychosocial, ergonomic and sport physiological aspects.