Der Schmerz
-
Among the possible reasons for low back pain, psychological factors are getting more attention. Early assessment of the stage of chronicity is important for successful therapy. The aim of the present study was to analyse the applicability of the Mainz Pain Staging System (MPSS) for chronic back pain outpatients. ⋯ The present study confirms the significance and usefulness of the MPSS applied to outpatients with back pain. To assess completely the stage of chronicity, psychological and physical/functional parameters should also be obtained.
-
The hypothesis that fibromyalgia (FM) should be classified as a somatoform disorder was assessed by reviewing current clinical studies. According to the ICD-10, somatic illness beliefs of the patient, high health care utilization, and frustrating patient-doctor relationships are diagnostic criteria of somatoform disorders. For the diagnosis of a somatoform pain disorder, a temporal association between the manifestation of pain and emotional or psychosocial conflicts and the exclusion of a depressive disorder are additionally required. ⋯ Yet in all studies there were patients who did not fulfill the ICD-10 criteria of a somatoform (pain) disorder. A biopsychosocial model of FM differentiating between biological as well as psychosocial predisposing, triggering, and perpetuating factors in the pathogenesis of FM is presented as an alternative model. Hopefully the biopsychosocial model and the distinction of subgroups will enable more differentiated and tailored psychotherapeutic and pharmacological treatment strategies.
-
Review Comparative Study
[Buprenorphine in children. A clinical and pharmacological review].
There is a paucity of relevant pediatric data on buprenorphine, especially with respect to the long-term application in children suffering chronic pain or to pediatric pharmacokinetic as well as pharmacodynamic data after repeated sublingual or long-term transdermal administration. Compared to adults, after single-dose buprenorphine, children seem to exhibit a larger clearance related to body weight and a longer duration of action. ⋯ Due to its various application routes, long duration of action, and metabolism largely independent of renal function buprenorphine is of special clinical interest in pediatrics, especially for postoperative pain and cancer pain control. There is no reason to expect effects fundamentally different from those in adults.
-
In children and adolescents we investigated the impact of a 3-week inpatient multimodal pain therapy on subjective burden of life, pain intensity, and number of days off from school 3, 6, or 12 months later. ⋯ Outpatient multimodal pain therapy has a sustained impact on children and adolescents suffering from chronic pain.
-
In pediatric oncology, optimal pain control is still a challenge. A structured pain history and the regular scoring of pain intensity using age-adapted measuring tools are hallmarks of optimal pain control. Psychological measures are as important as drug therapy in the prophylaxis or control of pain, especially when performing invasive procedures. ⋯ It is the responsibility of both nurse and doctor to guarantee emergency intervention during sedation whenever needed. In our guideline we comment on drug selection and dosage, pain measurement tools, and documentation tools for the purpose of pain control. Those tools may be easily integrated into daily routine.