Articles: acute-pain.
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Pain therapy with epidural or intrathecal catheters is an invasive method. These techniques have specific indications in both acute and chronic pain therapy. However, complications can occur. ⋯ Monitoring: During treatment with spinal catheters, adequate monitoring increases safety for the patients. Efficacy of the injections, puncture site and the neurological status should be documented daily. Neurological deficits must be diagnosed without losing time and adequate therapy must be initiated.
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[Development of a screening questionnaire to predict good and poor outcome of lumbar disc surgery.].
The aims were: (1) to investigate the prognostic value of pain history, sociodemographic, psychodiagnostic and medical factors for long-term outcome after lumbar disc surgery and (2) to develop a screening checklist of reliable predictors that distinguish between good and poor outcomes. ⋯ It is possible to determine for each patient a predictor sum that is prognostic for the individual risk of a poor operation outcome.
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The empirical use of oral acetylsalicylic acid (ASA) in the treatment of acute migraine attacks has led to the recommendation of ASA as a basic treatment of migraine. However, there are no controlled studies on the intravenous use of acetylsalicylic acid. ⋯ In this study i.v. ASA showed a significant reduction in pain intensity during migraine attacks. In addition, most concomitant non-pain symptoms were equally reduced. The onset of pain relief did not correspond with the inhibition of platelet aggregation (after 2-4 min) or with peak plasma concentrations of ASA (immediately after application) or salicylic acid (after 2-3 h). More efficacy studies with higher doses and longer periods of observation are necessary to optimize the treatment of migraine attacks with intravenous ASA. Studies including neurophysiological and vascular parameters are recommended to confirm the results of this study.
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Adjuvant analgesics are drugs that are not primarily used as analgesics but can produce analgesia in certain types of pain. Adjuvant analgesics can be administered together with non-opioid and opioid analgesics on each step of the WHO analgesic ladder. They should be given when an additional or specific indication exists, but should not be used as a substitute for a thorough treatment with opioids and nonopioids. ⋯ Biphosphonates (etidronate, clodronate, pamidronate derivates) also produce analgesic effects in patients with bone metastases. However, differences among the various compounds have not been clearly evaluated yet. Potent and specific radioisotopes are still under development and the use of calcitonin in bone pain is considered controversial.
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Outcome studies of lumbar disc surgery document a success rate ranging between 49% and 90%, according to the evaluation criteria used. The aim of the present study was to investigate the prognostic value of pain history and of sociodemographic, psychodiagnostic and medical factors for the long-term outcome after lumbar disc surgery. ⋯ Anamnestic information on the pain history and psychological factors have prognostic value for the outcome after lumbar disc surgery. If there is no absolute medical indication for disc surgery, we suggest reconsidering the treatment planned for patients with the risk factors specified.