Schmerz最新文献

Background: Retropharyngeal calcific tendinitis is an aseptic inflammation of the longus cervicis muscle. This rare acute pain disorder of the neck region is a prognostically benign condition compared to neurological or otorhinolaryngological differential diagnoses.

Objective: To capture the clinical appearance, diagnostics, treatment and course of this rare disease.

Material and methods: In this retrospective monocentric observational study, demographic, clinical, paraclinical as well as treatment and follow-up data of all inpatients with a diagnosis of retropharyngeal calcific tendinitis admitted to the Diako Hospital Mannheim in the years 2018 to 2021 were analyzed.

Results: This study included four female and one male patient with an age between 36 years and 77 years. Severe neck pain with restriction of cervical spine rotation was the leading clinical appearance, in four out of five patients there was a painful swallowing disorder. Inflammatory markers were elevated in four patients. Characteristic MRI or CT imaging alterations of the cervical spine confirmed the diagnosis. The symptoms resolved within 4-14 days after treatment with nonsteroidal anti-inflammatory drugs (NSAID) and four patients additionally received glucocorticoids. No recurrences were observed during the follow-up period of 5-30 months.

Conclusion: The good prognosis of this rare disease is reflected by the rapid remission of symptoms under NSAIDs and glucocorticoids and by the absence of recurrences during follow-up. CT or MRI imaging is required to rule out differential diagnoses, and to confirm the characteristic imaging alterations of retropharyngeal calcific tendinitis. Additionally, cerebrospinal fluid puncture and otorhinolaryngological assessment may be necessary in some cases.

Introduction: Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2 years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented.

Objectives: To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice.

Methods: This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented.

Results: Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needlerelated procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist.

Conclusion: There is evidence of effective pain management strategies for newborns, infants, and toddlers, and a great deal of effort is being made to translate knowledge into action.

Background: In pediatrics, adequate treatment with potent opioids requires the administration of sustained-release preparations for many patients; however, the dosing and administration of sustained-release morphine and hydromorphone preparations via gastrointestinal tubes confronts providers with a major hurdle, especially as the company Mundipharma GmbH has discontinued the production and distribution of the preparation MST retard granules in 2019, which has been proven for these purposes in pediatrics. The aim of this study was to establish a production technique for available sustained-release opioid preparations, which are particularly suitable for use in the low-dose range required in pediatrics and which can also be administered via gastrointestinal tubes.

Method: Low-dose preparations were produced by opening of morphine and hydromorphone capsules and weighing of the sustained-release pellets. To evaluate the partition, an analysis of the drug content via high performance liquid chromatography (HPLC) was conducted. Moreover, the administration via gastrointestinal tubes (charrière, Ch 8-Ch 10) was examined by an ex vivo experiment.

Results: The examination showed a practicable method to produce low dosages of sustained-release morphine and hydromorphone. The preparations are in accordance with the test for content uniformity of the European Pharmacopoeia (Ph. Eur.). Furthermore, the pellets were administered to gastrointestinal tubes Ch 8 (morphine) and Ch 10 (hydromorphone) by a syringe application technique and passed the tubes completely.

Conclusion: The production technique can be considered as safe and enables the off-label oral application or application via gastrointestinal tubes of sustained-release opioids in pediatrics.

Background: Patients often report uncertainty about the information provided by physicians and physiotherapists, as well as difficulties in making decisions regarding medical interventions. Making autonomous and informed decisions requires clear explanations about the condition, its associated limitations, prognosis, and treatment options.

Objective: This systematic review aimed to investigate how common diagnostic labels for the same musculoskeletal pathology influence the perceived severity of a condition and patients' treatment preferences.

Methods: Systematic literature search in MEDLINE (via PubMed), the Cochrane Library, and the PEDro database.

Results: Healthy individuals as well as patients associate diagnostic labels suggesting pathoanatomical damage in musculoskeletal pain syndromes with more pain, greater disability, and a perceived need for advanced imaging and invasive interventions. Overall, there is a significant correlation between diagnostic labels and patients' treatment preferences.

Discussion: Diagnostic labels such as "low back pain episode," "persistent hip pain," and "bursitis," which do not suggest severe structural damage, are often associated with a better prognosis and less perceived need for invasive interventions or advanced imaging. In contrast, labels indicating structural damage (e.g., "degeneration") can trigger fear, avoidance behaviour, and catastrophizing. Using labels that promote self-efficacy and convey a positive prognosis could therefore be a valuable strategy to improve care for patients with musculoskeletal pain.

Conclusion: Severe-sounding diagnostic labels are associated with a preference for more invasive treatments, catastrophizing tendencies, and a perceived need for advanced imaging in individuals with musculoskeletal pain.

Background: In palliative care, the focus of treatment is on controlling the patient's symptoms. To achieve this, drugs with addictive potential are often used. This can lead to addiction problems, as palliative care patients are surviving longer these days than they did a decade ago.

Aims: This study investigates whether drug misuse and substance abuse are perceived as a problem in specialised outpatient palliative care teams.

Materials and methods: A cross-sectional questionnaire survey was conducted among all German specialised outpatient palliative care teams (n = 366). Data were analysed descriptively.

Results: A total of 129 palliative care teams (35.2%) participated in the survey. Of these, 49.6% stated that an estimated 1-5% of their patients suffer from medication dependency and 65.9% estimate that 1-5% of their patients have drug abuse issues. In all, 69.8% of palliative care teams do not screen their patients for the presence of addiction, while 3.1% do so regularly. If an addiction problem is present, 65.9% of the teams do not take any action.

Conclusion: According to the available data, addiction is not considered a problem in German palliative care. However, it should be noted that almost no palliative care team screens patients for the presence of addiction, although more than half of the teams estimate that at least some patients have an addiction problem. Further research is needed here, as new therapies may help palliative care patients to live longer. It would be important for the development of palliative care and the quality of life of those affected to evaluate how to protect patients from iatrogenically induced substance abuse.

Complex regional pain syndrome (CRPS) is often associated with severe mental impairments. Initial pain-related fears in particular appear to be negative predictors for long-term therapy results. Procedures for cognitive behavioral therapy are an important component of treatment. The psychotherapy of CRPS consists of various elements that are implemented in the different phases of treatment. In the beginning the focus is on targeted psychoeducation. In the following activation phase body awareness exercises are accompanied by occupational and physiotherapeutic treatment in order to improve the perception of individual maximum loads. Behavioral analyses are used to uncover dysfunctional coping patterns, such as a fear avoidance coping strategy. In this case the use of graded activity treatment approach is indicated, in which the activity level is gradually increased. In the transfer phase psychotherapy supports affected patients in (re)designing their professional and private environments.