Beeinflußt die Schmerztherapie postoperative Morbidität und Letalität?

Postoperative pain can intensify the sympathoadrenergic reaction, which is commonly seen after surgery, and thus possibly pave the way for certain complications, such as coronary ischemia, bronchopneumonia, intestinal stasis, thromboembolism, infection, sepsis, and metabolic disturbances. Investigations of cardiovascular, respiratory, gastrointestinal, metabolic, and immunologic function indicate that high-quality pain relief can diminish postoperative organ impairment and failure. Some aspects of the improvements attributed to the quality of analgesia, such as prevention of tachycardia and hypertension, attenuation of hyperglycemia and catabolism, improvement of gastrointestinal motility and cellular immunity cannot be definitely distinguished from the effects of sympathetic blockade due to epidural analgesia with local anesthetics, however. There is another aspect of the problem. The better the quality of postoperative pain relief, the more likely it is that analgesia-related complications, such as respiratory depression (opioids), cardiovascular depression (epidural local anesthetics), renal failure (NSAIDs) and bladder dysfunction (epidural opioids and local anesthetics) will occur. The question of whether postoperative morbidity and mortality can be reduced by effective analgesia has been investigated in the past few years. Some studies indicate that better analgesia is advantageous for the patient, especially with respect to postoperative complications, hospital stay, long-term well being, and costs. In other clinical trials incorporating more patients, however, this hypothesis had to be rejected. At present, therefore, we cannot state that effective pain relief influences postoperative morbidity and mortality.     

Alternative Schmerztherapie: Harmlos und erfolgreich?

As a result of changing public attitudes non-orthodox methods of pain therapy have become widely accepted within everyday health care. The view that non-orthodox methods, even if not overly successful are at least harmless is widely held. The present paper gives examples that support the existence of three risk factors: (a) Delay in the diagnosis of curable diseases owing to alternative, non-orthodox forms of therapy. (b) Occurrence of serious or even life-threatening side-effects of non-orthodox forms of pain therapy. (c) Development of unusual diseases which are not easily diagnosed by the physician because he or she does not know that so-called natural or herbal products may be the reason for the symptoms. It is felt that these problems with non-orthodox pain therapy should be known by the physician. Patients should be questioned about the use of alternative methods of treatment and physicians should be aware of unwanted effects of acupuncture, cell therapy, Ajurvedic medicines and herbal therapies. In addition, they should know that some drugs sold as herbal products with "no side-effects" are enriched with e.g. phenylbutazone and/or corticoids, for example.     

P?diatrische Schmerztherapie

Background

In order to provide efficient pain treatment clinicians need to know the latest developments in pain management and to implement this knowledge into clinical practice. The knowledge of pediatric nursing staff with regards to pediatric pain management has not yet been investigated. In this study we therefore investigated nurses?? knowledge of pediatric pain management strategies.

Methods

Nursing staff knowledge was analyzed using the German version of the PNKAS-Sr2002. This questionnaire was distributed to 310?pediatric nurses and the response rate was 51.3% (n=159). Analyses of variance (ANOVA) were conducted to examine whether educational level and work experience had an influence on knowledge. Independent from work experience the educational level of nurses is important for their knowledge in pediatric pain management.

Results

On average nurses obtained a mean individual test score of 69.3%. Nurses with advanced qualification and nurses with 6?C10?years work experience obtained the highest scores.

Conclusion

Pediatric nurses must be trained more efficiently in pediatric pain management so that an adequate pain management is available for children and adolescents.     

Schmerztherapie bei Früh- und Neugeborenen

Pain is a central topic on neonatal intensive care units (NICU). Acute as well as prolonged (continuous and chronic) pain frequently occurs. Due to a lack of validated physiological measurement instruments for pain (e.?g. saliva cortisol, skin conductance and heart rate variability) pain in neonatology can only be assessed by external observation through the bedside team with pain scores using a regular, standardized procedure. During this very vulnerable period pain and medications (analgesics/sedatives) can negatively influence the brain development of premature babies and neonates. Therefore, limitation of the number of pain stimuli and the medicinal guideline “as much as necessary but as little as possible” are eminently important. When dealing with prolonged (continuous and chronic) pain, further challenges are a reduction of analgesics and sedatives as well as avoidance of withdrawal symptoms.     

Schmerztherapie bei chronisch schmerzkranken, schwer beeintr?chtigten Kindern und Jugendlichen

Background

A prospective study controlled for sex and age was conducted evaluating the success of a 3-week inpatient pain therapy after 3, 6 and 12?months for 200?children and adolescents severely disabled due to chronic pain.

Methods

The following validated German questionnaires were used: pain questionnaire (DSF-K/J/E), pain coping inventory (PPCI-R), anxiety questionnaire (AFS) and depression questionnaire (DIKJ). After an intention-to-treat analysis unifactorial und multifactorial variance analyses were conducted. A significance level of p<0.01 was used.

Results

Durable improvements were observed for average pain intensity, pain disability, days absent from school, depression and for passive and interaction-based pain coping strategies 3?months after finishing inpatient pain therapy. On the other hand general anxiety and school aversion were only reduced at 6 and 12?months, respectively. Girls reported more pain in general and during follow-up. Younger children relied in general more on others when dealing with their pain.

Conclusion

An inpatient pain therapy can help children and adolescents severely disabled due to chronic pain not only in the short term but also in the long term.     

Stabilit?t und Instabilit?t der Wirbels?ule im Alter

Mobility and stability of the vertebral column (VC) are a prerequisite for the diversity of human motoric behavior. Stability is understood as resistance against external force (disturbance) to prevent dislocation, minimize displacements, i.e. protection of a stable posture and of a defined range of mobility. The stability of the VC is dependent on passive and active structures and also motor control functions. Both structure and function may be disturbed and both can be subjected to abrasion and degeneration. Different points of view have different aspects when analyzing stability or instability. With increasing age the range of motion of the VC, especially extension, flexion and lateral flexion diminish in a non-linear way. Dynamic factors of stability of the VC are highest between the ages of 20 and 30 years and the greatest decline is in the elderly over 70 years of age. Local and segmental stability is not the focus of this paper. The age-related decline in the ability for sensorimotor regulation may be an aspect to elaborate different methods to sensitize and reintegrate sensorimotoric functions and therefore to restabilize the VC as a whole in posture and in movement.     

Pumpen und Ports zur medikamentösen Schmerztherapie

At one of the symposia at the 16th congress of the German Society for the Study of Pain in Berlin in 1991 an update on the use of pumps and ports in pain treatment was presented. This article tries to focus on some of the conclusions of this meeding. (1) To avoid neurologial damage only analgesic substances that have been tested in animals and with which we have adequate clinical experience, e.g. opiates, clonidine and baclofen, should be used for spinal anaesthesia. (2) The increasing number of manufactures of pumps, ports, catheters and puncture needles should pay more attention to safety and reliability of their products to avoid technical complications and should try to achieve compatibility between the different accessories such as catheters, needles and connecting pieces. (3) The mode of application (spinal versus epidural, pump versus port or externalized catheter) depends on the predicted period of treatment (spinal application for long-term treatment requires more hygienic precautions) and on differences in the individual care of the patient (4). Spinal opiates for benign pain (in case of failure of less invasive pain regiments) have been tested successfully, but the follow-up is not yet long enough to allow recommendation of this therapy for general use. (5) Local anaesthetics are useful for short-term use. The addition of local anaesthetics for continuous low-flow infusion of opiates requires further comparative studies. (6) Spinal baclofen is effective against pain induced by muscle spasms but not against non-spasticity-related pain syndrome.     

Multimodale Schmerztherapie bei chronischen und chronifizierenden Rückenschmerzen

Objectives

In recent years, multimodal treatment programs for chronic lower back pain (LBP) have been successfully established, however, the availability of such programs is limited. The aim of this study was to determine the predictors of success in a multimodal pain treatment program.

Methods

The study included 408 patients with chronic lower back or neck pain, who were admitted to a multimodal treatment program over 3 weeks. The German pain questionnaire was used for initial evaluation. Pain intensity was measured via VAS at the beginning of treatment and 6 months after therapy. The items on the pain questionnaire were tested by studying variance and regression analyses for their ability to predict treatment outcome (change of pain intensity).

Results

The following items could predict treatment outcome: duration of current pain episode, application for pension, pain intensity and job satisfaction. Age, sex, pain location (neck pain versus LBP) and chronicity stage according to MPSS were not found to be significant predictors.

Conclusions

According to our data, patients suffering from LBP or neck pain for less than 3 years, regardless of the stage of chronicity, can be expected to have a good outcome (pain reduction) after admission to a multimodal treatment program. Job satisfaction is a further predictor of good outcome. Predictors for a bad treatment outcome are: pain intensity less than 30/100 (VAS), pain duration longer than 3 years, and application for pension.     

Schmerztherapie bei Kindern und Jugendlichen mit Hämophilie

Background

Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated.

Objectives

This paper discusses how to improve pain management for children and adolescents (0–18 years) with hemophilia and which specific features in this population should influence decisions in pain management.

Materials and methods

An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience.

Result

Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.

     

Schmerztherapie bei chronischer Pankreatitis und chronisch-entzündlichen Darmerkrankungen

Apart from local inflammation and defects in secretion, central mechanisms are important for pain etiology in chronic pancreatitis. Therefore, centrally acting co-analgetic agents can be used in addition to classical pain medications. Endoscopic interventions are preferred in patients with obvious dilation of the pancreatic duct. Surgical interventions are generally more effective although they are usually reserved for patients with prior failure of conservative treatment. Diverse surgical options with different efficacies and morbidities are used in individual patients. One of the main problems in chronic inflammatory bowel diseases is abdominal pain. Primarily the underlying disease needs to be adequately treated. Symptomatic pain management will most likely include treatment with acetaminophen and tramadol as well as occasionally principles of a multimodal pain regimen. For the treatment of arthralgia as well as enteropathy-associated arthritis the same treatment options are available as for other spondyloarthritic disorders.     

Die Qualität der postoperativen Schmerztherapie beeinflusst die Krankenhauswahl

AIM: The aim of the survey was to elucidate the significance of postoperative pain therapy for the patient and its influence on the choice of hospital. METHODS: This prospective, anonymous survey of consecutive patients in a general surgical clinic was performed by an independent study nurse. RESULTS: A total of 161 patients were included; 90% of the surgical patients considered "good pain therapy" as a highly important factor, and three of four patients would admit themselves more likely to a clinic well known for "good pain therapy." If the patients could choose their hospital, factors such as "medical care by the physicians" are most important (rank 1; rank 1 most important, rank 10 most unimportant) followed by quality of "nursing care" (mean rank 2.6) and "good pain therapy" (mean rank 3.6). Older patients (> or = 60 years) preferred a hospital with known "good pain therapy" more often for surgical therapy than younger patients (< 60 years). CONCLUSION: It can be concluded that postoperative pain relief is an important factor for the patients' selection of a clinic and is influenced by an age of > or = 60 years.     

Was ist gesichert in der Schmerztherapie?

Ohne Zusammenfassung