Der Schmerz
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The German Society for the Study of Pain (DGSS) commissioned a meta-analytic review of the evidence on the long-term effects of opioids, non-opioid analgesics and cognitive- behavioral procedures for chronic non-cancer pain. A multidisciplinary expert panel was established to review the evidence and formulate recommendations as far as possible on the basis of means, standard deviations and group sizes from randomized controlled trials. ⋯ Therefore, the LONTS guidelines focus on the prevention of adverse effects and misuse and a multidisciplinary approach for the treatment of chronic pain is strongly recommended. Principles of opioid prescription and on the management of risks associated with the long-term use of opioids are described.
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This survey focussed on chronic postoperative pain and impairment of quality of life after living donor nephrectomy. ⋯ Measures have to be taken to prevent chronic postoperative pain and donors should be encouraged to express their pain to ensure an adequate pain therapy.
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We observed a patient with incomplete, cervical paraplegia and opioid-induced constipation who developed a resistance to laxatives after 15 years of treatment. The constipation-induced reduction in the patient's quality of life was improved using 12 mg methylnaltrexone, a peripheral mu-opioid receptor antagonist, administered subcutaneously twice a week.
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Most people would like to spend the end of their life at home in their familiar surroundings. Is it possible to look after and care for people at home if the work of doctors, carers and hospices is coordinated and comprehensive? ⋯ Our results indicate that by introducing a specialized structure for outpatient palliative care, including a specialized 24-h palliative medical service, an improvement in total care for patients at the end of their lives can be achieved.