Der Schmerz
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Postoperative pain assessment in children with cognitive impairment poses major challenges to healthcare professionals. Children with moderate to severe cognitive impairment are generally unable to communicate effectively and to self-report the level of pain. Difficulties assessing pain have led to their exclusion from clinical trials and rendered them vulnerable to insufficient treatment of pain. ⋯ Scales based on a child's own perception of pain and its severity play a limited role in this vulnerable population and pain assessment tools which rely on observing pain behavior are essential. The r-FLACC, which is reliable and valid, includes specific behavioral descriptors and can be used simply and effectively postoperatively in clinical practice. Our task has to be assessing pain as a routine procedure in cognitively impaired children as a keystone for an improved and successful pain management in this very sensitive patient population.
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Review Comparative Study
[Serotonin receptor 1A-modulated dephosphorylation of glycine receptor α3: a new molecular mechanism of breathing control for compensation of opioid-induced respiratory depression without loss of analgesia].
To control the breathing rhythm the medullary respiratory network generates periodic salvo activities for inspiration, post-inspiration and expiration. These are under permanent modulatory control by serotonergic neurons of the raphe which governs the degree of phosphorylation of the inhibitory glycine receptor α3. ⋯ Our physiological investigations show that this 5-HTR(1A)-GlyRα3 modulation allows treatment of respiratory depression due to opioids without affecting the desired analgesic effects of opioids. The molecular mechanism presented here opens new pharmacological possibilities to treat opioid-induced respiratory depression and respiratory disorders due to disturbed inhibitory synaptic transmission, such as hyperekplexia.
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The empirical findings on risk factors for a favorable/unfavorable outcome upraised via pain intensity, disability and functional capacity after empirically well-evaluated multimodal treatment are inconsistent. The objective of this study was to analyze the relevance of psychosocial and pain-related variables for therapeutic outcome in an unselected sample of patients with chronic non-specific back pain (CBP). ⋯ The calculated regressions showed only a moderate ability to predict or explain the outcomes pain intensity, disability and functional capacity. However, depression and body mass index (BMI) were significantly related to pain-related therapeutic outcome.
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The effect of interdisciplinary multimodal therapy of chronic back pain is well documented. With elapsing time changing diagnostic focuses, therapeutic strategies and objectives have to be considered. ⋯ The requirement of a rational causal therapy in chronic back pain still remains but the focal points shift to the consideration of somatic, psychological and social disposing and supporting factors. The aim of this paper is to reflect the necessary orthopedic expertise in the context of the pathomechanics of chronic back pain and the interdisciplinary teamwork.