Der Schmerz
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Bisphosphonates (BP) are used in the treatment of severe osteoporosis and metastasis of malignant diseases. A possible relationship between the occurrence of osteonecrosis of the jaw and BP therapy was first described in 2003. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is difficult to treat. In some cases the condition of the patients is so compromised that only minimally invasive surgery is possible. Histopathologically, osteonecrosis shows the features of chronic sequestered osteomyelitis, which can be found in different areas of the upper and lower jaw. Sometimes extensive resections of the jaw are necessary. Thus, BRONJ can cause mutilation, impairment of function and esthetics in the orofacial system and, thereby, compromise the life quality of the patients. Triggering factors are often tooth extraction without surgical plastic wound closure of the alveoli, but can also be associated with bruises from denture or other minor wounds. ⋯ Because of the complex symptoms, close cooperation between oncologists, dentists, and maxillofacial surgeons is required in the treatment of BRONJ. Before starting therapy with bisphosphonates and during the therapy, dental treatment and monitoring of the patient' oral health is necessary.
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In recent decades there has been much work on cognitive behavioral approaches to chronic pain. Now there is a considerable variety of concepts and interventions which share the same roots but differ in theoretical issues and application. ⋯ The latter have been influencing therapy and theory in recent years. The cognitive behavioral perspective on chronic pain has, therefore, not only become more differentiated and complex but also more complicated.
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We report on two patients with schizoaffective psychosis, cancer, and pain. However, it is not possible to make somatic or psychic disturbances alone responsible for the pain. In patients with current schizoaffective disorders, only administration of a combination of psychopharmaceutical and opioid agents is successful.
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The current debate about end-of-life decisions in Germany focuses on physician-assisted suicide (PAS). However, there is only limited information available on physicians' attitudes towards euthanasia or PAS, and no data on nurses' attitudes. ⋯ The fact that nurses had a more positive attitude towards euthanasia and PAS and that all respondents accepted life-ending acts for themselves more than for their patients hints to still existing severe deficits in Germany.