Articles: chronic-pain.
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Oral medication is the simplest way in treatment of chronic pain. For cancer pain oral analgesics are efficacious in more than 90% of the patients. When a causal therapy of pain (e.g. chemotherapy, operation) fails an analgesic ladder with oral analgesics is instituted. ⋯ In any state of pain the response to the different groups of drugs should be evaluated first. Then a stepwise pharmacological approach should be performed. In most cases pain can be treated effectively by oral drugs.
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Present-day hypotheses about the origin of pain in deep tissues are based on the idea that pain is anindependent sensation with its own specialized apparatus of sensors, conduction pathways and centers. The sensors are callednociceptors ornocisensors, and the neuronal structures they activate are thenociceptive system. Accordingly, the reception, conduction and central nervous processing of noxious signals together are termednociception. ⋯ Finally an account is presented of pain produced by excitation of the nociceptive system proximal to the nociceptors. These pain states include pain resulting from pathophysiological impulse generation in nociceptive fibers (neuralgia orneuralgic pain) which usually projects into the region containing the sensory endings of these fibers (projected pain). Furthermore, brief descriptions of pain due to spinal root compression and ofcentral pain arising from various sites of the central nervous system are given.
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The analgesic effectiveness of physical therapy in rheumatology is dependent on the differentiated clinical picture (joint, soft parts, spinal column, musculature) and on the differentiated therapeutic remedy (intensity, duration of single treatments, frequency, duration of therapeutic series). Physico- and kinesitherapy can be distinguished with regard to objective and subjective doses; manual therapy is between them. ⋯ The problem "rheumatism and pain" mainly exists at the level of "chronic"; diagnostics of movement function (articular and muscular functions) on one hand and dosage of therapeutic remedies (drugs and remedies of physiotherapy) on the other are the guidelines. Course (rehabilitation) as well as onset (prevention) of rheumatic clinical pictures determine the further strategy of pain therapy.
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The use of implantable systems for intrathecal administration of opioids in chronic pain of non-malignant origin is a controversial subject. Opioid therapy is reserved mainly for pain patients with malignant disease and reduced life-expectancy. The main reasons for this restricted range of indications of chronic subarachnoid administration of opioids are fear of addiction and the build-up of tolerance. ⋯ It seems that neuropathic and deafferentation pain syndroms are susceptible to intrathecal opioids. The initial daily average dose of morphine was 2.6 mg/day, increasing to 6.1 mg/day after 25 months without the development of major tachyphylaxis. the administration of intrathecal opioids by means of implantable systems is justified in carefully selected patients with chronic non-malignant pain. This method should be applied in preference to destructive neurosurgical treatments.