Der Schmerz
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Thirty patients who had undergone elective anterolateral thoracotomy were studied in the surgical intensive care unit to compare the analgesic effectiveness of i.v. self-administered buprenorphine (group A) with that of epidural administration (group B) and of s.c. administration by a nurse of 0.3 mg buprenorphine every 3-4 h (group C, controls). Every 2 h the patients were asked to record their subjektive pain level as a percentage on an analogue scale: zero was to be used for no pain and 100% for the most severe pain they could imagine. the mean of all analogue scores for pain in the first 36 h was 19.4+/-3.1 for group A; 18.4+/-2.3 for group B and 42.0+/-7.4 for group C (P<0.025). When the mean scores were referred to time, it seemed that groups A and B suffered a little more pain immediately after the operation; however, after 4 h the mean scores for these groups were far lower than that for the control group. ⋯ Nurses should be instructed to provide analgesic medication on demand. Epidural administration of buprenorphine is superior to self-administration in terms of the amount of drugs used and the dosing intervals. In the quality of analgesia epidural administration and self-administration are equal and superior to the control procedure.
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Despite all of the progress that has been made in diagnostic procedures and the increasing number of treatment facilities available the number of people suffering from chronic pain conditions seems to be growing constantly in all industrialized countries, a fact which is demonstrated impressively by the epidemiology of low back pain. "Chronic" means "life-determining"-chronic pain, as all chronic illnesses represent a turning point in the life situation of the people concerned. They not only affect the patients, but also the members of their immediate social environment. Chronic pain becomes a destructive stigma when society reduces the afflicted persons to the status of the chronically ill. ⋯ The introduction of the concept of the "healthy pain patient" has the goal of raising the competence of the individual and his/her social environment to improve the quality of life in spite of chronic pain. The educational aim is to enable patients with pain to be autonomous and to maximize their potential health. The therapeutic approach is demonstrated by individual case histories.
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In clinical pychology, the Gate Control Theory of pain (GCT) is considered a milestone among the psychological approaches to pain. In this paper ten critical issues are raised against the GCT. It is argued that GCT should be abandoned as a basis for the psychological study of pain. ⋯ Second, the methodological consequences that accompany the model are considered. Third, research evidence on the validity of the model is given, in particular with regard to the relationship between pain experience and subjective stress, as well as between pain experience and coping with the pain. Finally, further research questions are formulated.