Der Schmerz
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Non-pharmaceutical procedures are increasingly being used in pediatric pain therapy in addition to pharmaceutical procedures and have a supporting function. This article describes the non-pharmaceutical procedures which have an influence on perioperative and posttraumatic pain in children and adolescents. Prerequisites for every adequate pain therapy are affection, imparting a feeling of security, distraction and the creation of a child-oriented environment. ⋯ Psychological methods can facilitate coping with pain. In situations with mental and psychiatric comorbidities or psychosocial impairment, a psychologist should be consulted. Acupuncture and hypnosis are also a meaningful addition within the framework of multimodal pain therapy.
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Pharmaceuticals are not always licensed for all medically indicated areas and types of application. The off label use of pharmaceuticals is particularly common in pediatrics. The obligatory licensing of pharmaceuticals according to § 7 AMG (drug registration and administration act) only applies to the dispensing and provision but not for the use in patients, particularly in a perioperative setting. ⋯ Pharmaceuticals can only be used after obtaining appropriate informed consent. The off label use of medications is allowed and sometimes necessary under these prerequisites as long as the administration of the medication is medically indicated and shows promise of success. Furthermore, an application can be permissible for"curative intent".
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Practice Guideline
[Regional anesthesia procedures in childhood : Austrian interdisciplinary recommendations on pediatric perioperative pain management].
Regional anesthesia should be used for children whenever possible and is an essential element of a multimodal pain management. The prerequisites for a safe and effective procedure are detailed knowledge of the anatomical, physiological and pharmacological differences in childhood, the use of age-appropriate equipment and rapid recognition and treatment of possible complications. Extensive experience in pediatric as well as regional anesthesia is essential. ⋯ The use will lead to an increased level of acceptance and user-friendliness of the procedure in childhood. This article presents recommendations which demonstrate those points that must be generally observed when carrying out regional anesthesia in children. An overview of the regional anesthesia procedure in children is given.
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Postherpetic neuralgia is considered to be a neuropathic pain syndrome. Typically, patients experience pain in the dermatomes of skin lesions persisting for more than 3 months after skin restitution. About 10% of patients with herpes zoster develop postherpetic neuralgia. ⋯ Clinical studies did show pain relief in postherpetic neuralgia after administration of antidepressants, antiepileptic drugs, opioids, and topical capsaicin and lidocaine. Nevertheless, about one third of patients do not respond to conventional treatment. Given the fact that postherpetic neuralgia is considered to be a chronic pain disease, a multidisciplinary treatment approach is necessary.
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Practice Guideline
[Pediatric perioperative systemic pain therapy : Austrian interdisciplinary recommendations on pediatric perioperative pain management].
Many analgesics used in adult medicine are not licensed for pediatric use. Licensing limitations do not, however, justify that children are deprived of a sufficient pain therapy particularly in perioperative pain therapy. The treatment is principally oriented to the strength of the pain. Due to the degree of pain caused, intramuscular and subcutaneous injections should be avoided generally. ⋯ Ketamine is used as an adjuvant in postoperative pain therapy and is recommended for use in pediatric sedation and analgosedation.