Der Schmerz
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The alpha(2)-adrenoceptor agonist clonidine has analgesic properties comparable to those of opioids after systemic administration. It also has antihypertensive, antiemetic, anxiolytic, sedative and antisialogogue effects and reduces the incidence of shivering. Thus, the pharmacodynamic profile of clonidine seems to suit it quite well for the special problems related to recovery from anaesthesia. ⋯ This paper reviews previous experience with systemic administration of alpha(2)-adrenoceptor agonists for postoperative pain relief. Especially in combination with low-dose opioids, clonidine leads to a similar or even better level of pain relief with significantly reduced adverse side effects compared with opioid mono-therapy, perhaps because different sites of action are addressed and influence nociception. Therefore, balanced postoperative analgesia including alpha(2)-adrenoceptor agonists, therefore seems to be a beneficial addition to differentiated postoperative pain relief.
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Chronic pain is often associated with an array of general psychological dimensions such as depression, somatic symptoms, anxiety, anger and a loss of quality of life. Part VIII describes various instruments concerning each dimension and comments on their applicability within a diagnostic routine for chronic pain patients. ⋯ Trait-anxiety and pain-unrelated state-anxiety seem not to be suitable because they lack significance for the therapy process. While the inventory for assessing anger still needs an empirical basis for chronic pain patients, quality of life inventories are not recommended for routine pain assessment.