Der Schmerz
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Despite psychosocial factors playing an important role in the course of chronic pain disorder, there is a noticeable imbalance between demand and availability of psychosomatic care for these patients. This led us to establish a psychosomatic pain clinic within the framework of our outpatient clinic at the Department of Psychosomatic Medicine and Psychotherapy at the Central Institute of Mental Health, Mannheim, Germany. A recent study aimed at the evaluation of sociodemographic variables, state of chronification, symptom load and psychiatric comorbidity. Additionally we wanted to determine whether existing conditions at our hospital can be considered suitable for those patients. ⋯ Our examination routine effectively demonstrated the special needs of chronic pain patients. As there is significant demand for psychosomatic intervention in those patients, earlier referral appears highly desirable. As pain patients differ also greatly from the remaining hospital population, specialized therapeutic concepts must be developed.
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The somatosensory system of preterms and newborns differs substantially from adults. These differences are of considerable preclinical and clinical interest. Maturation of A- and C-fibre synaptic connections in the dorsal horn and development of descending inhibition from the brainstem all take place postnatally in the rat. In early stages of development there is no definite spatial separation in the dorsal horn between the nociceptive and the non-nociceptive system. In preterms but not in adults non-noxious stimuli can induce central sensitization. Many neurotransmitters and signalling molecules involved in pain pathways are expressed early in the developing nervous system but do not reach adult levels for a considerable period. More important, receptors are frequently transiently overexpressed or expressed in areas during development where they are not seen in the adult and may have a different functional profile. The descending pain inhibitory system that provides an important protection against central sensitization develops later than the ascending nociceptive system. Thus, during a critical period of time the immature nociceptive system is highly vulnerable. For example, neonatal circumcision in the absence of analgesia results in increased pain responses during subsequent routine vaccination months later. ⋯ In view of the changing nature of neonatal somatosensory and pain pathways and the vulnerability of the developing nervous system to alterations in sensory stimulation it is important that preterms and newborns need the care of a specialist for prevention and treatment of pain to avoid suffer and long-term changes in the nervous system.
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TREATMENT OF PAIN: Undertreatment of postoperative pain in children is a problem in clinical practice. This is due to a lack of both knowledge about age-specific aspects of physiology and pharmacology, and routine pain assessment. ⋯ NON-OPIOID ANALGESICS: Non-opioid analgesics are recommended for basic pain treatment after minor surgical procedures. Instead of using the whole multitude of drugs available, the doctor should stick to those drugs he is familiar with (acetaminophen, ibuprofen, diclofenac, dipyrone).
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Repeated assessment of pain and other symptoms is required for quality assurance in palliative care. However, physical and cognitive impairment of the patients may impede the use of standardized questionnaires and documentation systems in palliative care setting. We developed a minimal documentation system (MIDOS) for the specific requirements in this setting. ⋯ We conclude that MIDOS is a valid instrument for self-assessment of the patient's symptoms and may be used to monitor the efficacy of symptom management.
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A minimal documentation system (MIDOS) has been developed for self-assessment of pain and other symptoms by the patients on palliative care units. To decrease the administrative burden and thereby increase the acceptance of the system an electronic database was developed to facilitate data entry and documentation. ⋯ This data base was used in two trials on the palliative care unit of the university of Cologne, confirming data safety and convenience of the programme. We recommend the use of this data base in combination with MIDOS and the core documentation for routine assessment on the palliative care ward.