Der Schmerz
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We report 8 in-patients with nonmalignant chronic pain (main diagnosis: 7 somatoform pain disorders, 1 eating disorder) and with abuse of opioid therapy, which we have treated within 2 years in an tertiary centre. In all patients the inefficacy of opioids with regard to pain symptomatology could be demonstrated. Because the ICD-10 criteria of addiction cannot be fully applied to patients under opioid therapy because of chronic pain we suggest as criteria the intake of opioids because of positive psychotropic effects, the demand of high dosage of short acting opioids with inefficacy of similar long acting opioids dosage, the uncontrolled raising of dosage with illegal procurement and reluctance of the patient to stop opioid therapy because of proved inefficacy of pain control. ⋯ Therefore a qualified psychotherapeutic evaluation before starting an opioid therapy for nonmalignant pain in order to exclude a somatoform pain disorder or to assess a substance dependency is mandatory. Patients with somatoform pain disorder should be treated with opioids only in clinical studies. A prior or present history of substance abuse given chronic opioid therapy for nonmalignant pain should only be performed in close cooperation of addiction- and pain therapists.
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Even in the last century cannabis was used in the treatment of chronic pain. The main active component of cannabis Delta-9-Tetrahydrocannabinol (THC) has been increasingly used in the treatment of nausea, vomiting, loss of appetite and depression. It is also recommended in the treatment of chronic pain. We present our first experiences with THC in the treatment of patients with chronic pain. ⋯ This retrospective evaluation of 6 case reports of patients treated with THC showed large individual differences in the effectiveness of THC in pain management. Prospective studies are necessary to evaluate the importance THC in the treatment of chronic pain.
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Testing the validity of the Mainz Pain Staging System (MPSS) is often carried out by pain classification according to chronic stage. It is assumed that pain syndromes distribute equally over the chronic stages. This analysis was carried out to answer three questions: Do different pain syndromes vary in chronicity, do the four axes of the MPSS differ between pain syndromes, and are there any specific item responses with respect to a pain syndrome? ⋯ Using pain stages of the MPSS as an experimental factor in studies of pain, it is imperative either to control pain syndromes or to confine to a single pain syndrome, to avoid confusion between pain syndromes and severity of pain chronification.
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The objective of this study was to evaluate the clinical outcome of CT-guided radiofrequency- (RF-)thermocoagulation of cervical zygapophysial joints for chronic non radicular cervical pain syndrome using an improved posterior approach. ⋯ CT-guided radiofrequency thermocoagulation is an effective, precise and secure, minimally invasive treatment for non radicular cervical pain that is caused by zygapophysial joint arthropathy, when CT-guided, lateral drug instillation does not cause a lasting improvement.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative transcutaneous electrical nerve stimulation (TENS) in shoulder surgery (randomized, double blind, placebo controlled pilot trial)].
The aim of this study was to determine whether 3 days of TENS therapy postoperatively after shoulder operations would result in better pain relief and/or reduced analgesic intake when compared to placebo. ⋯ We were able to show in this study that TENS applied postoperatively after shoulder surgery clearly reduced analgesic consumption in the first 72 hours. Furthermore there was a significant difference in the pain scores using the "Hamburg Pain Adjective List" in favour of the verum group. TENS applied postoperatively is a effective, simple modality with few side-effects.