Articles: pain-clinics.
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Tick-borne borreliosis (Borrelia burgdorferi) is a common and complex disorder affecting the skin, the joints and the nervous system. It progresses through different clinical stages. The clinical spectrum of neuroborreliosis has expanded since the introduction and widespread application of specific serological tests. ⋯ Therefore, borreliosis can be assumed to produce a painful skin dystrophy like SRD or ACA by direct injury to the sympathetic nerves even in the early clinical stage of the infection. The main conditions to be considered in the differential diagnosis are polymyalgia rheumatica; lumbar disk herniation; inflammatory radiculopathies of other origin (e.g. herpes zoster); painful neuropathies, including the diabetic thoraco-abdominal form; internal disorders of chest and abdomen with referred pain; lymphocytic meningitis of other origin, encephalomyelitis; and sympathetic reflex dystrophy. High-dose penicillin G i.v. is a potent analgesic in all patients with tick-borne neuroborreliosis.
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In repeated clinical studies a preponderance of pain syndromes on the left side of the body has frequently been observed. Experimental studies in humans revealed a lower pain threshold on the left, nondominant side. On the other hand, some studies do not confirm this lateralization. ⋯ For pain induced by pressure, lateral asymmetry increased with pain intensity, for the other two methods it was constant. Lateral asymmetry was found in all subjects, but significant differences could only be demonstrated in female Ss. It is concluded that both gender and handedness contribute to lateral asymmetry of pain sensitivity in man.
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A short survey about the different methods available for producing postoperative analgesia is given, the goal being to make it clear to the clinician that there are quite a number of techniques to be used although the everyday clinical practice often sticks to simple and not too effective methods of pain treatment following surgery. Initially presenting short informations about the neurophysiology of pain and the pathogenesis and causes of postoperative pain two main groups of producing analgesia are then discussed. Thefirst group deals with the systemic use of analgesics be it nonnarcotic analgesic antipyretics or narcotic analgesics (opioids). ⋯ They present clear advantages over the local anesthetic methods as there are the long lasting analgesia and the selective blockade of pain not touching motor and sympathetic nerve fibers. A delayed respiratory depression however might be a serious danger showing an incidence of 0,3% in the epidural and some 10% in the subarachnoid route. Aiming to inform the clinician once again about the vast field of possibilities available to make the postoperative course painfree it is hoped that this important task in the postoperative period will be handled with more consequence and effectivity in the future.