Der Schmerz
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The empirical use of oral acetylsalicylic acid (ASA) in the treatment of acute migraine attacks has led to the recommendation of ASA as a basic treatment of migraine. However, there are no controlled studies on the intravenous use of acetylsalicylic acid. ⋯ In this study i.v. ASA showed a significant reduction in pain intensity during migraine attacks. In addition, most concomitant non-pain symptoms were equally reduced. The onset of pain relief did not correspond with the inhibition of platelet aggregation (after 2-4 min) or with peak plasma concentrations of ASA (immediately after application) or salicylic acid (after 2-3 h). More efficacy studies with higher doses and longer periods of observation are necessary to optimize the treatment of migraine attacks with intravenous ASA. Studies including neurophysiological and vascular parameters are recommended to confirm the results of this study.
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For pain therapy different methods of application are essential, because side effects or swallowing difficulties may prevent the natural oral application of analgesics. Up to now only tablets have been available for sustained-release morphine. We investigated a suspension of this drug in different pain states. ⋯ These first results show that liquid slow-release morphine suspension can provide pain relief similar to slow-release morphine tablets. Consequently, slow-release liquid morphine suspension provides a suitable alternative, especially in patients with swallowing disorders.
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Pain diaries are modern evaluation instruments for assessment of pain dynamics and treatment outcome. There are syndrome-specific and non-syndrome-specific diaries. They exist as paper-and-pencil versions, as electronic diaries or as uptime recorders. ⋯ Due to the effort required by diary analysis the use of pain diaries seems to be indicated only if there is the intention to generate quantitative data by mathematical-statistical methods. Problems arise, in spite of the quantitative data level, from the limited comparability of results and the undeniable reactivity of measurements. At present open questions refer to the desirable or non-desirable stability of surveys by means of pain diaries and the possible generation of secondary effects as the result of long-term diary recording.