Der Schmerz
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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.
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In the industrialized nations headache prevalence is increasing in children and adolescents. The nosologic classification determines the therapeutic strategy to follow. ⋯ We discuss the patients' courses, diagnostic pitfalls, and therapeutic options. For the optimal treatment of children with headache not easily fitting into one of the categories, with significant comorbidity present, or if there is no adequate response to therapy conforming with guidelines, the help of an interdisciplinary pediatric pain clinic is invaluable.
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A number of surgical procedures for pediatric patients can be suitably performed in an outpatient setting. The advantages are impressive: reduced costs, lower rate of infection, avoidance of hospitalization with the inherent psychological stress, and timely return of the patients to their familiar home environment. An essential feature of the quality of outpatient surgery is the efficacy of the perioperative pain therapy for which a multimodal approach has proven to be very effective: workflow tailored to children's needs, ambiance appropriate for children, and pharmacological analgesia. ⋯ When opioids are employed, care should be taken that monitoring standards in the recovery room are not lowered and include pulsoxymetry. Because of the clearly elevated rate of postoperative nausea and vomiting related to perioperative administration of opioids, the lower dosage level should be chosen. This article presents concepts of perioperative analgesia.
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Spinal cord stimulation (SCS) is an effective alternative treatment in patients with chronic neuropathic pain and mainly radicular distribution. The aim of this prospective study was to investigate changes in BOLD signal with fMRI during active SCS and to correlate the results with the clinical pain intensity, measured with a visual analogue scale (VAS). ⋯ In patients with chronic neuropathic pain and high VAS levels, SCS elicited BOLD activation in the cingulate gyrus, thalamus, prefrontal cortex, and primary and secondary somatosensory area. Pain reduction by SCS resulted in a reduction of functional activity in these areas as revealed by follow-up fMRI.