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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Pain is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. A painful stimulus elicits an activation of receptors in the periphery which transduce the stimulus into an electrical impulse. This electrical impulse is transmitted to the dorsal horn of the spinal cord and subsequently to the brain. ⋯ In parallel, endogenous control mechanisms, in which predominantly the opioid but also other systems are involved, counteract these pathological changes. Both the initiation of pain and its control can be regarded as the body's response to prevent further injury, to support wound healing, and to return to a normal function as quickly as possible. The transition from acute to chronic pain may critically depend on disturbances of the intrinsic pain control mechanisms as well as on effective therapeutic measures, initiated at the earliest possible time.
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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.