Der Schmerz
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Local wound perfusion with bupivacaine after elective abdominal surgery seems to be a promising method of reducing postoperative pain. Applicability, effectiveness, side effects and risks were tested in a pilot study with 28 patients. During closure of the laparotomy incision two catheters were inserted, one between peritoneum and fascia and the other subcutaneously. ⋯ No severe side effects occurred, but the study was interrupted nonetheless in 3 patients, 2 of whom had a transit syndrome while the third had more severe hypotension than could be explained by the bupivacaine blood level. No infections and no problems with wound healing occurred during the study. This study proved that the method tested leads to significant pain reduction after elective abdominal surgery and has no severe side effects.
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A total of 97 patients with an acute monoradicular lumbosacral compression syndrome and a herniated disc at the same level were reinvestigated an average of 25 months after the acute event. Assessment was based on CT investigation and "root score", which was compiled from reports of subjective complaints and neurological deficits. All patients had initially undergone conservative treatment as inpatients. ⋯ In the majority of cases, during the further course of the disease the herniated disc causes no pain. It appears, therefore, that the course of disease following a disc herniation can be influenced very favourably by non-operative treatment and that in more than 50% of cases the condition becomes clinically silent. It follows that in neuroradicular compression syndromes a neurological deficit associated with the acute event does not mean operative intervention is indicated.
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There are no valid data available for Germany on the prevalence of migraine using the new diagnostic and classification criteria of the International Headache Society (IHS). ⋯ For methodological reasons our study may underestimate the true prevalence of migraine in Germany. Taking our rather "conservative" figures into account, our study reveals, however, that there are more than 2 million migraine sufferers in Germany between 16 and 69 years of age.
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The article describes the interdisciplinary treatment of chronic pain at the Center of Pain Studies (CPS). The CPS is an intergral part of the Rehabilitation Institute in Chicago. An essential part of the program is a 1-day outpatient evaluation in which members of all disciplines take part. ⋯ General aims of the treatment are to return to productive life, improve emplopyability, increase activity level, improve mobility, apply pain management techniques, and improve coping. The program is monitored by an evaluation/follow-up system. Success criteria of the 6-month follow-up for the years 1987-91, such as less daily downtime in 58-78% of the patients, more time out on weekends in 40-68%, return to work in 50-67% and reduced depression in 37-70%, give an impression of the effectiveness of the pain management program.
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Drug therapy for the prevention of migraine attacks is becoming more and attacks is becoming more and more important. The aims of such prophylactic treatment are to reach a lower frequency, shorter duration and milder intensity of migraine attacks, and to reduce the intake of anti-migraine medication, to improve the quality of life and working ability. The question of efficacy and tolerance of established migraine prophylactics [1] has been thoroughly investigated in many studies. So far the question of sustained efficacy after a successful prophylactic treatment completion has not been a research priority, but it is nonetheless of great importance. Researchers at the neurologic scientific research institute of the university of Naples have followed up migraine out-patients after successful prophylactic treatment and observed that prophylactic agents differ not only in their immediate efficacy and safety, but also in long-term efficacy. Therefore, an open pilot study was performed with the prophylactic agents propranolol, flunarizine, pizotifen, DHE retard, methysergide and cyclandelate in the recommended dossages (Tabe 1). ⋯ In spite of the uncontrolled pilot design, it can be said in summary that all prophylactic drugs were effective. Cyclandelate had a good safety profile, and in efficacy it was at least comparable to the other prophylactic drugs. Patients treated with cyclandelate had a longer duration of active treatment and likewise a longer period of follow up. In addition, the proportion of patients with "no indication for repeated prophylaxis" at follow up was higher than for any of the other drugs. The results are interesting for medical practice and suggest replication in a randomized blind study. If the results yielded by the present study are confirmed, cyclandelate should be classified as a drug of first choice for migraine prophylaxis.