Der Schmerz
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Many studies investigated patient-controlled analgesia (PCA) in the postoperative period in recovery rooms under anaesthesiologic monitoring but reports on the advantages and indications of PCA in surgical wards are scarce. The aim of this prospective study therefore was to investigate PCA as a routine technique in surgical wards. In particular we were interested in safety and in the efficacy of analgesia. ⋯ We conclude that PCA with piritramide is a safe technique when performed under routine conditions on surgical wards. However, standardized monitoring is mandatory. PCA leads to effective analgesia and consequently to greater comfort of surgical patients in the postoperative period. These conclusions hold only for patients with ASA status I-II who have undergone operations of the types listed above.
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PCAO (patient-controlled analgesia in outpatients) is a new treatment concept designed to overcome chronic or acute pain of cancer patients. From 1989 to 1992, a total of with tumour pain 204 patients were treated in the pain clinics of Fürth in cooperation with the Department of Radiation at the University Hospital in Regensburg. In 90 of these patients adequate oral medication was impossible because of problems in swallowing or blockage of the gastrointestinal tract, and subcutaneous opioid infusion over 24 h was therefore instituted. ⋯ PCAO for treatment of cancer patients at home yields freedom from of pain around the clock, independence, and quality of life with active personal involvement. The most important thing is that the patient can sleep during the night, as can the doctor, the nurse and relatives, as they do not need to give injections during the night. This new method of treating the pain of cancer patients at home in advanced disease is also well accepted by social security authorities, as it reduces the costs dramatically.
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Up to 70% of cancer patients in the terminal phase of their disease complain of moderate or severe pain. Pain therapy in these patients follows the analgesic ladder of the WHO. Many cancer patients will need a strong opioid to get sufficient pain relief. ⋯ The transdermal application of a strong opioid may be an alternative, especially for patients with cancer of the head and neck or in the gastrointestinal tract. Because of the pharmacokinetic laziness of the system the use of Fentanyl-TTS should be limited to patients with stable tumor pain. In these patients Fentanyl-TTS might be valuabe on step III of the analgesic ladder of the WHO or as an alternative to invasive methods when it is impossible to administer oral opioids.
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Animal experiments have unequivocally demonstrated peripheral antinociceptive effects of opioids in inflamed tissue. Exogenous mu-, delta- und kappa-agonists can produce such effects. Opioid receptors are present on peripheral terminals of primary afferent neurons and their endogenous ligands are produced and contained in resident immune cells within the inflamed tissue. ⋯ A small number of clinical studies has examined the peripheral analgesic effects of opioids. Their results are equivocal so far. In view of the predominant role of the inflammatory process in the manifestation of peripheral opioid effects, the postoperative situation seems to be particularly worthwhile to study.
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The period of late exteroceptive suppression (ES 2) of the temporalis muscle is often shortened in patients with chronic tension-type headache. The present study was conducted to find out whether the ES 2 is influenced by muscle relaxation training and whether it is rather a state or a trait marker. ⋯ The duration of ES 2 was modified by a muscle relaxation training in patients with chronic tension-type headache. Therefore, ES 2 is a state marker and is probably influenced by limbic structures. Measurement of ES 2 may not be only a diagnostic tool, but could also be useful in monitoring results of therapy in patients with tension-type headache.