Der Schmerz
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Deep brain stimulation (DBS) of the posterior hypothalamic area is a new treatment option for patients with refractory chronic cluster headache (CCH). A review of the literature reveals that studies based on large numbers of patients, long-term observations and controlled randomised trials are still lacking. In 2006 a case report of the first patient in Germany to be operated on to allow DBS was published, and we now present a report of this patient's course in the first 6 months after the operation; in addition, a current literature review is discussed. ⋯ DBS in the posterior hypothalamic area is an invasive treatment option for use in cases with CCH that is refractory to any pharmacological therapy. As demonstrated by this case report, it is not possible to give a prognosis concerning its long-term efficacy: despite the initial excellent benefit there can be a reduction and even a loss of the effect of stimulation. The clinical results and long-term follow-up observations of the few cases published so far need to be evaluated in a larger multicentre trial with a double-blind study design.
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Comparative Study
[Pain clinics within Austrian hospitals, for patients with pathologies of the locomotor system. Analysis of care and comparison with Germany].
This paper gives a comparative overview of the current clinical care of patients experiencing pain in the musculoskeletal system in Austria and in Germany. The questionnaire used in this study was modified from one used in a survey carried out in Germany in 2002. In our version we asked specifically about pain in the musculoskeletal system. ⋯ In 17.4% of the clinics in Austria there are plans to extend the pain therapy they offer, but in over half of the hospitals that responded facilities for pain therapy are considered to be vulnerable. The study highlights a significant higher percentage of in-patient pain therapy services in Austria, while in Germany, in contrast, there are more outpatient options for pain therapy. The quality of pain therapy could by further improved by more intense cooperation between the inpatient and outpatient sectors and by the establishment of interdisciplinary and multimodal solutions.
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It is well known that patients with dementia complain less about pain and receive fewer analgesics than other patients. The question arises of whether disorders associated with dementia change the processing of pain. ⋯ Our findings suggest that the processing of acute noxious stimuli is intensified in patients with dementia. Against the background of a reduced prescription of analgesics, an under-treatment of pain in patients with dementia might be the consequence.
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Over the last decades, functional imaging studies have fostered our knowledge of cerebral pain processing in humans. A lively interest has been focussing on possible opioidergic mechanisms of pain transmission and modulation. Today, reliable knowledge of the in vivo distribution of opioid receptors in healthy human subjects is available from positron emission tomography (PET) studies of opioidergic neurotransmission. ⋯ Thereby, the ACC apparently executes cortical top-down control on brainstem structures in (exogenous) pharmacological opioid analgesia. In addition, accumulating evidence suggests that non-pharmacological treatment approaches also utilize similar endogenous opioid dependent pathways to exert pain modulation. This article summarizes our current knowledge of PET studies of the opioidergic system and outlines future perspectives.
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Multicenter Study
[Oral transmucosal fentanyl citrate for the treatment of breakthrough pain. Results of a non-interventional study (NIS)].
In a non-interventional study the efficacy and tolerability of oral transmucosal fentanyl citrate (OTFC) was studied in patients with opioid-treated cancer pain suffering from breakthrough pain. ⋯ Oral transmucosal fentanyl citrate is a safe and effective treatment for breakthrough pain in chronic cancer-related pain.