Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Sympathetic reflex dystrophy and phantom pain. Diagnosis, therapy and prognosis].
The incidence of phantom limb pain has been significantly underestimated for many years. However, studies published during the recent decade indicate that the real incidence of phantom limb pain may be between 60% and 90%. Reflex sympathetic dystrophy (RSD) occurs with an incidence of about 15.000 new cases every year in Germany. ⋯ None of the patients treated with a combination of local anaesthetics and low dose morphine developed phantom limb pain. Therapy of choice for RSD is the sympathetic blockade. The most suitable method is intravenous regional sympathetic blockade (IVRSB) with guanethidine (2).
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Indications and limits of nerve block techniques].
Repetitive nerve blocks as a monotherapeutic treatment are loosing importance in the therapy of chronic pain. Such invasive methods for pain reduction are just one strategy in the interdisciplinary and multimodal planning of pain therapy. ⋯ Furthermore, it is necessary for the physician to know the typical complications of the invasive treatment and to be able to manage them. It is recommended to document the pain course.
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Non-opioid analgesics and co-analgesics in therapy of chronic pain].
Efficacy and side effects of non-opioid-analgesics were analysed in a standardized review of placebo-controlled or double-blind studies. In rheumatoid arthritis, ibuprofen showed the best ratio of effectiveness and side-effects. Naproxen, diclofenac and meloxicam may serve as alternatives. ⋯ The dose administered in the management of chronic pain should be low in order to reduce the incidence of side-effects. The frequency of side-effect-related discontinuation of chronic pain medication was calculated as follows: ibuprofen 3.8%, aspirin 4.7%, piroxicam 4.8%, naproxen 7.4%, meloxicam 13.0% and diclofenac 17.8%. Since differences in efficacy were not clinically relevant, the indication for a special non-opioid-analgesic medication should focus on the prevention of side-effects.
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Psychologic strategies for the treatment of chronic pain are an important component of the necessary multidimensional treatment for patients in chronic pain. These techniques including relaxation training, biofeedback, hypnosis and cognitive-behavioral therapy have demonstrated efficacy. ⋯ In Germany there are still several impediments for the consequent application of psychologic strategies for patients with chronic pain. These impediments and possible solutions are discussed.
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Back pain is a common disease causing tremendous costs for treatment, rehabilitation, pension payments and work-loss. The reasons of back pain vary considerably and often remain doubtful. The effectiveness of current treatment concepts has not yet been proven significantly. In accordance with the literature, in chronic pain only multimodal concepts of treatment seem to be successful as far as they take care about somatic, psycho-social, and sport physiological aspects.