Der Schmerz
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A central antinociceptive effect of calcitonin has been well established in animal experiments. Owing to the lack of appropriate studies, however, a final judgement cannot be made regarding the value of calcitonin in pain therapy. Positive clinical experiences have been reported in the following cases. (1) In isolated osseous tumor pain and in pain caused by tumorous infiltration of peripheral nerve tissue or acute malignant transverse lesions of the spinal cord (with paraplegia), calcitonin can be a suitable supplement to opiate therapy. (2) In algodystrophy calcitonin can be administered in addition to physical therapy. ⋯ Dangerous side-effects have not been reported to date. However, dose-dependent side-effects occur frequently, which the patients often consider very distressing. The disadvantages and the "escape" phenomenon that occur during longterm use restrict the value of calcitonin as an analgesic.
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The relationship of patients' pain with emotions and irrational attitudes were reported. The subjects were 128 patients with rheumatoid arthritis (RA). The assessment instruments were the Situation-Reaction Questionnaire (SRQ) and the Irrational Attitudes Questionnaire (IAQ). ⋯ On the other hand, when medical variables and irrational attitudes were controlled, emotions showed no common variation to pain. According to our results, cognitive concepts seem to be more powerful for explaining pain experience and pain behavior than affective constructions. Implications for the study and the practice of psychological pain treatment are discussed.
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In this randomized study, the efficacy of i.v. patient-controlled analgesia (PCA) was determined for the opioid piritramide (a pure mu-receptor agonist) and the antipyretic analgesic metamizole (Dipyrone) in three groups of patients following abdominal surgery. The doses of piritramide were 1.5 mg (40 patients) and 3 mg (40 patients) on demand. In addition, we studied the effect of 71 mg metamizole in combination with on-demand boluses of 1.5 mg piritramide in 40 patients. ⋯ The intensity of typical side effects of opioids and antipyretic analgesics (nausea, vomiting, lowering of respiratory frequency, sweating) was low and always easily controlled. The acceptance by patients, nurses, and physicians of PCA was high. PCA with on-demand intravenous injection of the combination of piritramide and metamizole improved the degree of analgesia and concomitantly reduced the opioid dose.
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Idiopathic headaches are probably the most common problem in schoolchildren. The prevalence increases up to 70% in 14-year-old adolescents, with migraines ranging from 10% to 20%. Tension headaches are often understandable on a psychosocial and behavioral basis; in migraine, however, a familial disposition of 60%-80% is well known. ⋯ It is presently unknown, whether pharmacological prophylaxis during several months followed by attack-free periods of months or years may influence the long-term prognosis. For tension headaches, transcutaneous electrical nerve stimulation (TENS) has produced good improvement in recent investigations in about 3/4 of cases; full remissions were possible in most cases. A combination of relaxation and behavioral therapy should be recommended where possible, especially in cases of therapeutic resistance.