Der Schmerz
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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.
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We report on two patients with neuropathic knee pain following lesions of the infrapatellar branch of the femoral nerve due to knee joint replacement. In one patient, the neuropathic pain syndrome was complicated by the development of complex regional pain syndrome (CPRS II, causalgia). ⋯ This nerve is a branch of the femoral nerve medial to the fascia lata and is responsible for the skin sensation of the anterior and medial part of the knee. Clinical features, anatomy, diagnostic methods and therapeutic options are reviewed.