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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The diagnosis and therapy of pain is routine in common practice of almost all clinical fields. Whilst acute pain may be controlled fairly easily, the treatment of chronic pain patients may be frustrating if conventional approaches for analgesia are chosen. Only a specialized and multidisciplinary procedure is beneficial for advanced stages of pain chronification. Precisely, an adequate treatment program has to consider biological, psychological and social aspects of chronic pain.
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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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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.