Articles: pain-clinics.
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alpha(2)-Adrenoceptor agonists like clonidine, dexmedetomidine, and ST-91, inhibit nociceptive reflex activity predominantly by a spinal mode of action. They mimic the action of the inhibitory transmitter noradrenaline, which is released from the terminals of bulbospinal monoaminergic pathways. The inhibition by noradrenaline is due partly to hyperpolarization of the postsynaptic neuronal membrane; however, the selective antinociceptive effect of the alpha(2)-adrenoceptor agonists results from reduction of the release of the excitatory transmitters such as glutamate and substance P, blockade of the binding of substance P to spinal neurones, and enhancement of the action of the inhibitory transmitter, 5-hydroxytryptamine. ⋯ Moreover, impulse conduction in C fibres of peripheral nerves is far more reduced by these compounds than that in A fibres. Antinociceptive effects are reported to occur in various models of clinical pain, e.g. the formalin test, adjuvans-induced arthritis, autotomy following deafferentation, and "hyperalgesia" after nerve ligation. Therefore, the mechanisms involved in antinociception may also be responsible for the analgesia produced by alpha(2)-adrenoceptor agonists.
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According to the German Drug Law of 1976 the present status of scientific knowledge regarding the benefit/risk-ratio of combination analgesics was reevaluated and is summarized taking the fixed combination of paracetamol plus acetylsalicylic acid as an example. The extensive discussion of the responsible committee for reevaluation of drugs B-3 (Neurology/Psychiatry) at the German Federal Institute of Health (Bundesgesundheitsamt) led to the following results as viewed by the involved members: - the fixed combination has its pharmacological rationale (secure detoxification, even with high single doses; (over)additive analgesic effect in experimental models. - the benefit of the fixed combination is given by a potentially lower liver toxicity as proven with experimental models and by an (over)additive efficacy in cancer pain or headache. - combination-specific risks surpassing the ones of the single substances are not recognizable. ⋯ Even though the clinical efficacy has been proven only in few specific studies the evaluation of the benefit/risk-ratio appears to be positive regarding the not recognizable combination-specific risks. The combination is recommended for acute use.
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Disability is a central aspect in the assessment of chronic pain patients. Disability questionnaires in German (developed or adapted) are examined and selected for different purposes. The "Funktionsfragebogen Hannover" and the "Pain Disability Index" are recommended for both research and clinicalapplication while the "Sickness Impact Profile" is suitable only for research purposes. ⋯ There are some empirical data for three of them. Only the "Inventory of Familial Adaptability and Cohesion" has achieved a certain degree of empirical maturity. Further research and developmental activity in this area of pain assessment are urgently needed.
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Patients with chronic headache are seen in an interdisciplinary pain clinic after many years of treatment. Compared with other pain syndromes, the standards for diagnosis and treatment are widely accepted according to the guidelines of the International Headache Society. Nevertheless, many patients continue to suffer. Analysis of their special clinical features may help to clarify what kind of conditions potentially cause chronicity. ⋯ The results are discussed with respect to their relevance in explaining development of chronic pain, as seen in selected headache patients in an interdisciplinary pain clinic.
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The present paper is one of a series of publications, reviewing German instruments for psychological assessment of pain. Their main focus is on the results of a task force on quality testing for each subject. This paper describes and comments on methods regarding self-reporting of pain cognitions and both cognitive and behavioral strategies for coping with pain. ⋯ A similar procedure was followed with instruments for the assessment of pain-related coping strategies. According to our research there are two subgroups of coping instruments, one more specifically for cognitive coping with pain, and the other combined with behavioral coping strategies. Once again, we elaborated a specific and differential recommendation, giving priority to instruments taking account of both cognitive and behavioral dimensions of coping with pain.