Articles: analgesics.
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Most patients with very advanced cancer suffer from severe pain, and many studies have demonstrated how this pain can be sufficiently controlled. It is of great importance to find out if the findings are also true during the final stage of cancer and how the treatment must be adapted. We therefore examined the methods and efficacy of providing pain relief for dying cancer patients. ⋯ Only 4% of the patients treated in the way described experienced severe pain during the final stage of cancer. Systemic administration of drugs is very effective in relieving pain in dying patients. No signs of tolerance to opioids could be observed, even in patients who had been taking opioids for a longer period of time (average 39 days).
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A central antinociceptive effect of calcitonin has been well established in animal experiments. Owing to the lack of appropriate studies, however, a final judgement cannot be made regarding the value of calcitonin in pain therapy. Positive clinical experiences have been reported in the following cases. (1) In isolated osseous tumor pain and in pain caused by tumorous infiltration of peripheral nerve tissue or acute malignant transverse lesions of the spinal cord (with paraplegia), calcitonin can be a suitable supplement to opiate therapy. (2) In algodystrophy calcitonin can be administered in addition to physical therapy. ⋯ Dangerous side-effects have not been reported to date. However, dose-dependent side-effects occur frequently, which the patients often consider very distressing. The disadvantages and the "escape" phenomenon that occur during longterm use restrict the value of calcitonin as an analgesic.
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Opioids are given for acute intra- and postope-rative pain relief or for chronic cancer pain. In the literature there are only rare and contradictory reports on the oral administration of opioids for chronic non-malignant pain. However, there is no reason to withhold strong analgesics for patients with severe pain. ⋯ Side effects are controlled by additional medication. The principle of opioid administration is prophylaxis of pain -therefore, they should be given "by the clock". Opioids are not only indicated in malignant illness, but also according to severity of pain and by the failure of other measures to control pain.
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In this randomized study, the efficacy of i.v. patient-controlled analgesia (PCA) was determined for the opioid piritramide (a pure mu-receptor agonist) and the antipyretic analgesic metamizole (Dipyrone) in three groups of patients following abdominal surgery. The doses of piritramide were 1.5 mg (40 patients) and 3 mg (40 patients) on demand. In addition, we studied the effect of 71 mg metamizole in combination with on-demand boluses of 1.5 mg piritramide in 40 patients. ⋯ The intensity of typical side effects of opioids and antipyretic analgesics (nausea, vomiting, lowering of respiratory frequency, sweating) was low and always easily controlled. The acceptance by patients, nurses, and physicians of PCA was high. PCA with on-demand intravenous injection of the combination of piritramide and metamizole improved the degree of analgesia and concomitantly reduced the opioid dose.
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Idiopathic headaches are probably the most common problem in schoolchildren. The prevalence increases up to 70% in 14-year-old adolescents, with migraines ranging from 10% to 20%. Tension headaches are often understandable on a psychosocial and behavioral basis; in migraine, however, a familial disposition of 60%-80% is well known. ⋯ It is presently unknown, whether pharmacological prophylaxis during several months followed by attack-free periods of months or years may influence the long-term prognosis. For tension headaches, transcutaneous electrical nerve stimulation (TENS) has produced good improvement in recent investigations in about 3/4 of cases; full remissions were possible in most cases. A combination of relaxation and behavioral therapy should be recommended where possible, especially in cases of therapeutic resistance.