Articles: pain-clinics.
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Adjuvant analgesics are drugs that are not primarily used as analgesics but can produce analgesia in certain types of pain. Adjuvant analgesics can be administered together with non-opioid and opioid analgesics on each step of the WHO analgesic ladder. They should be given when an additional or specific indication exists, but should not be used as a substitute for a thorough treatment with opioids and nonopioids. ⋯ Biphosphonates (etidronate, clodronate, pamidronate derivates) also produce analgesic effects in patients with bone metastases. However, differences among the various compounds have not been clearly evaluated yet. Potent and specific radioisotopes are still under development and the use of calcitonin in bone pain is considered controversial.
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Effective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point. Recent reports suggest 80-90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects. ⋯ Apparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.
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Unfortunately, sharp, severe pain in the area of distribution of the fifth cranial nerve is frequently termed trigeminal neuralgia, and no differentiation is made between typical and atypical neuralgia and other types of facial pain disorders. This can lead to inadequate treatment. ⋯ The process of differential diagnosis is critical in trigeminal neuralgia, because an incorrent or missed diagnosis is one of the most frequent causes of treatment failure. As idiopathic trigeminal neuralgia, craniomandibular disorders or the cervical spine syndrome can involve similar symptoms and response to the use of medication, close interdisciplinary cooperation in the process of diagnosis is recommended.
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This is the first in a series of publications presenting the results of a taskforce on quality assurance in psychological assessment of chronic pain. The initiative was motivated by the increasing and confusing variety of newly developed German instruments and/or translations of Anglo-American instruments. Our main work was therefore concentrated on the collection of existing German assessment instruments, on summarizing the essentials in a documentary sheet, and on examining their objectivity, reliability, validity, clinical relevance, economy and degree of empirical foundation. For each diagnostic domain we thus elaborated specific differential recommendations for those working in psychological pain research and clinical practice, in an attempt to devise criteria enabling them to choose the optimal instrument or test battery for their needs and conditions.
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Since the development during the sixties of the pioneer pain clinics in the United-States, the need of a pluridisciplinary approach of the chronic pain patient has progressively compelled recognition. The principles of organization of this new care units--the pin center--are now clearly determined. It has become classic to compare acute pain as a warning symptom with chronic pain as an illness in itself with its constellation of psychosocial factors. ⋯ Neurophysiological, neuropsychological and behavioral differences legitimate the acute/chronic distinction. We will consider the following items: the types of patient, the multidisciplinary model, the team functioning, the initial consultation, the multidisciplinary synthesis discussion, the somatician role, the psychiatrist role and the possible disadvantages. Beside the care mission, multidisciplinary pain centers also have a key role in clinical research and teaching.