Articles: chronic.
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Dextropropoxyphene is a mild opioid analgesic whose analgesic potency corresponds to that of acetylsalicylic acid and paracetamol. It has a similar analgesic effect to codeine but also a considerably lower addiction and dependence potential. Dextropropoxyphene is a therapeutic alternative to other weak opioids such as codeine or dihydrocodeine. ⋯ Repeated administration of the sustained-release form at the therapeutically recommended intervals does not lead to cumulation, and the risk of accidental overdosage is extremely low. Intoxication can only occur after simultaneous ingestion of alcohol or other centrally depressant substances or in the presence of hepatic and/or renal failure. Sustained-release dextropropoxyphene is a sensible and undeniable alternative for the second stage in the analgesic ladder of chronic pain therapy.
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After the initial clinical reports of Shealy 1967 dorsal column stimulation (DCS) was first introduced in Germany by Krainick (Freiburg) and Winkelmüller (Hannover) in 1972. At first, the success rate in unselected patients was unsatisfactory. The results improved with careful patient selection and better technical equipment allowing preliminary testing procedures before definitive implantation. ⋯ The best indications and target group are cases with radicular low-back pain after failed back surgery, stump and phantom pain, pain states following partial lesions of brachial/lumbar plexus and peripheral nerves, sympathetic dystrophy and rest pain in peripheral vascular disease (PVD). Possible indications for SCS are pain after incomplete lesions of spinal cord or cauda equina, postherpetic neuralgia, sclerodermia and PVD. Failures must be expected in pain states related to progressive malignant disease and complete deafferentation after spinal lesions or root avulsion.
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The rationale for the use of spinal cord stimulation (SCS) in the treatment of chronic pain arose from Melzack and Wall's gate theory of the control of pain (1965). Originally electrodes were placed directly on the spinal cord via open operation, while now they are placed by means of direct puncture the epidural space. ⋯ The implantation of an SCS system is a surgical procedure, which requires the highest standards in asepsis. The operation and its complications and ways of avoiding them are described.
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Medical treatment with effective opioids for patients who suffer chronic pain is greatly lacking in Germany, as is supported by the documentation from Sorge and Zenz. The author comments on this documentation and adds an account of his own experience with the provision of opioid prescriptions over a period of almost 6 years. He asserts that the number of patients who suffer from pain has increased and argues for extending the indications for opioid therapy to include noncancer patients, giving reasons why pure morphine preparations are to be preferred. Finally, the author expresses his belief that only an expanded and appropriate application of today's concepts regarding treatment with analgesics and opioids will be able to clear the way for a liberalization of the laws regulating the prescription of opioids.
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Practitioners often rely on physiodiagnostic indicators to corroborate the hypothesis of a muscular origin of headache. Although these indicators have been widely applied, their reliability and validity have seldom been tested empirically in headache sufferers. In a controlled double blind study, two trained raters palpated muscle tension and latent and active myogeloses of the left and right trapezius and sternocleidomastoideus muscles and measured passive head rotation flexibility. ⋯ In keeping with the hypothesis, the various parameters of active myogeloses very clearly differentiated between the experimental groups. The hypothesis turned out not to be true for the parameters of head rotation flexibility. In subjects suffering from tension headache, no correlations could be found between the number of myogeloses of the right trapezius muscle and parameters recorded in long-term EMGs of this muscle, and no correlations could be found between the total number of myogeloses and the chronicity of headache.