Therapeutische Umschau. Revue thérapeutique
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Pain represents the most frequent complaint for which patients ask for medical help. Successful treatment of acute and chronic pain syndromes largely depends on the knowledge and the therapy of the underlying disease process and on the rational use of analgesics, such as the nonnarcotic analgesic-antipyretics, the anti-inflammatory agents and the opioid analgesics. ⋯ For this purpose it is important to follow some general principles of pain management and to consider the relevant pharmacokinetic and pharmacodynamic properties of the various analgesics. This overview summarizes the most important pharmacological properties of the widely used analgetic drugs, with special emphasis on their risk-benefit ratio in various clinical situations.
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Even though hypnosis is a very old form of therapy, a number of points still need to be made clear. We do know, however, that endorphins are not involved in the pain control process and that hypnosis effects and placebos are quite different. ⋯ The use is more limited in the case of acute pain, because the developments in modern anaesthesia preclude the use of hypnosis in the fields of surgery and dentistry. On the other hand, hypnosis can be helpful for patients suffering from burns, cancer pain, or other chronic pain.
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Signs of cardiovascular diseases have been found in more than 50% of elderly people over 65 years in industrialized countries. Congestive heart failure is an especially disabling consequence in up to 49% of the age-class 75 to 80 years. ⋯ For an adequate management of congestive heart failure in the elderly, one should consider specific age-related changes of the heart muscle cell, of the myocardial structure, of the vessel wall as well as functional changes of cardiovascular regulation, e.g. blunted reflexes and disturbed feed-back loops of hormonal regulation. Moreover, pharmacokinetic and pharmacodynamic properties of medicaments differ in elderly people, which should be considered for an age-adapted specific management of congestive heart failure in this patient-group.