Der Schmerz
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Establishing a trustful therapeutic relationship and reflecting on attitudes and behavior is essential in caring for patients with functional pain syndromes. Hope-disappointment circles are common and can be intensified by unfavorable caregiver behavior. A biopsychosocial, empathetic and coping-oriented attitude has proved to be useful. A motivating communication is recommended that carefully explores the pain and its interactions with psychosocial factors following the three typical phases of accepting complaints, establishing biopsychosocial understanding and developing coping strategies.
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Data on administrative prevalence, types of treatment and disease costs of patients diagnosed with somatoform pain disorder (according to ICD 10) in Germany were not previously available. ⋯ Insurants diagnosed with somatoform pain disorder were probably overtreated with radiology and invasive procedures and with opioids.
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The recent introduction of amendments to the medical licensure laws led to the introduction of the field of pain medicine into the study program "Human Medicine". The implementation has to be completed by all medical faculties before 2016. ⋯ The DGSS curriculum is a useful tool for the implementation of pain medicine in a study program. In order to improve access to basic pain medicine in general, a combined teaching program consisting of pain medicine and general medicine could be helpful. Pain medicine could be used as a guide for teaching contents of outpatient medicine.
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Case Reports
[DRESS syndrome : Rare and potentially lethal allergic reaction to carbamazepine-a case report].
A 64-year-old man with chronic low back pain had been treated with tramadol, meloxicam and metamizole for several years. Due to additional neuropathic pain in the lower extremities, the medication was complemented with carbamazepine. After 5 weeks of treatment, the patient developed maculopapulose exanthema and fever, followed by hepatitis, leukocytosis and eosinophilia. ⋯ The previously diagnosed neuropathic pain syndrome cannot be verified. After appropriate modification of therapy, the patient's pain perception was significantly reduced, allowing for complete withdrawal of pain-relieving medication. This case report illustrates that merely pharmacological treatment of chronic pain syndromes bears only little prospect of success but increased risk of side effects.