Der Schmerz
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Clinical pain syndromes affecting the locomotor apparatus can become apparent not only in the form of nociceptive pain in the skeleto-mechanical system, but also as neurogenic pain emanating from lesions in the peripheral nerves or nerve roots or as referred pain resulting from disorders of visceral organs. The anatomical structure and basic innervation can contribute to the various characteristics of such deep pain. Within the spinal cord, visceral and somatic afferent fibres converge on nociceptive pathways, resulting in a uniform clinical pain syndrome. ⋯ There is no doubt that these drugs can help a great deal. However, they have only a symptomatic effect without any influence on the origin or course of the disease. Therefore, a critical evaluation of their benefits and risks is required before treatment with such drugs is instituted.
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We evaluated the efficiency of sublingual buprenorphine (Temgesic((R)) sublingual, Boehringer Mannheim GmbH) in a controlled study over a minimum of 4 weeks in 15 patients with extreme cancer pain. The tumors included 8 locoregional carcinoma recurrences in the head and neck region, 4 distant metastases of primary squamous cell carcinoma in the oral and maxillo-facial region, 1 tumor after irradiation, 1 non-Hodgkin's lymphoma, and 1 primarily non-operable carcinoma. Pain intensity was continually documented by means of a visual analogue scale (VAS) by the patients themselves. In 14 of 15 the patients it was possible to reduce pain rapidly to one fifth the original intensity with a comparatively low dosage of 0.60 mg buprenorphine (median) daily.