Der Orthopäde
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Review Comparative Study
[Patients with pre-existing chronic pain and/or psychological problems].
Existing pain chronification and psychological problems can affect the degree of perioperative pain and hence the postoperative outcome. Most elective surgery performed on the musculoskeletal system is indicated because of pain. To avoid perioperative complications it is therefore essential to identify patients with existing pain chronification before surgery is performed. ⋯ In line with what is known about the mechanisms of pain chronification, patients with existing chronification usually display additional psychological problems. These psychological factors ought to be established prior to surgery. A preliminary non-surgical treatment could potentially also lead to a reassessment of the indication for surgery.
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Surgery of the shoulder, elbow, and hand can cause considerable pain. According to data from randomized controlled trials, local or regional anesthesia is recommended for analgesia during and after surgery of the upper extremity. ⋯ For the elbow joint, a peripheral block is also recommended to allow for effective analgesia and physiotherapy postoperatively. In addition, cooling and physiotherapeutic techniques are beneficial in postoperative management.
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This article describes the history of pain therapy and anesthesiology with respect to the field of surgery. The history of this part of medicine is dependent upon the development of the appropriate medication groups, which were of great importance in the field of pain therapy and anesthesiology. ⋯ The above mentioned developments combined with the knowledge of physiology of pain and new results from psychological studies led to the modern pain therapy in recent perioperative treatment concepts. Modern pain therapy is a multimodal therapy concept with a variety of specialties working as a team to optimize an individualized therapy plan which respects the needs of every single patient under different circumstances (acute, perioperative and chronic pain).
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Comparative Study
[Value of adjuvant physiotherapy in postoperative pain management].
In times of limited financial and human resources the application of adjuvant physiotherapy postoperatively in orthopaedic patients requires reevaluation. In the early postoperative course physiotherapy improves the patients' mobility. However, it is not able to reduce the need for pain medication. ⋯ In contrast, massages are of minor importance in the immediate postoperative course and are applied only in a few selected cases. Cryotherapy plays a major role especially after shoulder and knee surgery. On the other hand, transcutaneous electrical nerve stimulation (TENS) and acupuncture are applied only in selected patients after orthopaedic surgery, e.g., after limb amputation.
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Orthopaedic and traumatized patients often suffer from severe pain after surgery or trauma. Their early recovery also depends on an efficient acute pain relief based on a combination of systemic medication, local drug application and physical therapy. In 2007, new guidelines for the treatment of perioperative and traumatic pain were published. ⋯ It is helpful to establish an acute pain service for daily rounds and documentation. The individual patient should be informed about his specific acute pain therapy before the operation. Pain scores should be frequently documented by the patient.