Articles: pain-management.
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Wien Med Wochenschr · Jan 2000
Review Case Reports[Principles and application of acupuncture in neurology].
Acupuncture is a valuable method of complementary medicine with broad application in neurology. It is based on the experiences of traditional Chinese medicine as well as on experimentally proven biological (biochemical and neurophysiological) effects. Acupuncture-induced analgesia is mediated by inhibition of pain transmission at a spinal level and activation of central pain-modulating centers by release of opioids and other peptides that can be prevented by opioid antagonists (naloxone). ⋯ Clinical experience and controlled studies confirmed the efficacy of acupuncture in various pain syndromes (tension headache, migraine, trigeminal neuralgia, posttraumatic pain, lumbar syndrome, ischialgia, etc.) and suggest favorable effects in the rehabilitation of peripheral facial nerve palsy and after stroke. Appropriate techniques, hygiene safeguards and knowledge of contraindications will minimize the risks of rare side effects of acupuncture which represents a valuable adjunction to the treatment repertoire in modern neurology. There is sufficient evidence of acupuncture to expand its use into conventional medicine and to encourage further studies of its pathophysiology and clinical value.
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Neuropathic pain is a challenge for clinicians because it is resistant to commonly prescribed analgesics, such as opioids and nonsteroidal antiinflammatory drugs. Fortunately, adjuvant analgesics, drugs not typically thought of as pain relievers, may be effective. It is helpful to classify adjuvant analgesics used to treat neuropathic pain into two broad categories: (1) membrane stabilizing agents, which inhibit ectopic discharges on damaged neural membranes, and (2) drugs that enhance dorsal horn inhibition, which may augment biogenic amine or GABAergic mechanisms in the dorsal horn of the spinal cord. ⋯ Although polypharmacy is the result, this approach may improve therapy and minimize side effects. From a safety standpoint, medications generally should be started at low doses and titrated to effect. Although labor-intensive, this strategy can improve compliance and optimize patient care.
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The dearth of empirical support for interventions in pediatric chronic and disease-related pain requires a shift in our treatments and treatment research. Treatments with a higher degree of treatment accommodation are needed to reduce the treatment demands on patients and their families. ⋯ Likewise, treatment research will need higher levels of research acceptability to ensure adequate data demonstrating the true efficacy of treatments. A more creative approach is needed that incorporates technology as a tool to these ends.
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Subjective well-being is an essential ingredient in the quality of life concept. The Marburg questionnaire, a seven item scale for the assessment of the trait dimension of well-being, claims to possess good psychometric properties. This is investigated in two studies with chronic pain patients. ⋯ The good psychometric quality of the questionnaire along with its brevity allows its application as part of a quality of life assessment.