BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
Acute Pain/drug therapy , Agranulocytosis/chemically induced , Analgesics, Non-Narcotic/therapeutic use , Dipyrone/therapeutic use , Perioperative Period , Societies, Medical , Analgesics, Non-Narcotic/adverse effects , Anesthesiology , Dipyrone/adverse effects , Germany , Humans , Switzerland
BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
Acute Pain , Anesthesiology , Anti-Inflammatory Agents, Non-Steroidal , Dipyrone , Acute Pain/drug therapy , Analgesics , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Critical Care , Dipyrone/therapeutic use , Humans
BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
Agranulocytosis , Dipyrone , Acute Pain/drug therapy , Acute Pain/prevention & control , Agranulocytosis/chemically induced , Agranulocytosis/prevention & control , Analgesics/administration & dosage , Analgesics/adverse effects , Anesthesiology/standards , Association , Critical Care , Dipyrone/administration & dosage , Dipyrone/adverse effects , Humans , Perioperative Period
BACKGROUND: The intensity of postoperative pain is characterized by large interindividual variability. Furthermore, strong postoperative pain is known to influence physical recovery after surgery. High (preoperative) pain expectation and pre-existing pain, which are associated with pain-related disability (impairing pain) are risk factors for strong postoperative pain. They can be determined with the Lübeck Pain Risk Questionnaire used for the first time in this study. The aim of this study was to explore the hypothesis that patients with a combination of the characteristics (1) preoperative impairing pain and (2) high pain expectation are more likely to have strong postoperative pain. Patients with these characteristics represent a unique group of patients and are more likely to develop distinct postoperative pain and can therefore be characterized as a risk group. MATERIAL AND METHODS: A total of 501 patients at the departments of general surgery, plastic surgery, trauma surgery and orthopedic surgery of the UKSH Campus Lübeck were included in this study. All underwent elective surgery. Study patients were 18 years and older. Those needing postoperative treatment in an intensive care unit were excluded from this study (nâ¯= 18). The characteristics "preoperative pain" and "pain expectation" were measured with the Lübeck Pain Risk Questionnaire the day before surgery. The primary outcome variable was the average postoperative pain intensity, which was measured with a numeric rating scale (NRS 0-10) and scores > 4 were defined as severe pain. RESULTS: The NRS range for "preoperative pain" was subdivided as follows: "no pain" (NRSâ¯= 0), "functional pain" (NRSâ¯= 1-3), and "impairing pain" (NRSâ¯= 4-10); that for "pain expectation" as: "low expectation" (NRSâ¯= 0-4) and "high expectation" (NRSâ¯= 5-10). To determine these cut-off points, they were varied from > 1 to > 8 and those with highest effect size for strong postoperative pain were chosen. Patients with a high pain expectation had significantly stronger postoperative pain (pâ¯< 0.001) and significantly more often higher pain intensity than patients with a low expectation (53.3% vs. 20.6%, respectively, pâ¯< 0.001). Patients with pre-existing impairing pain had significantly stronger and more frequently higher postoperative pain than patients with pre-existing functional pain (43.4% vs. 18.4%, pâ¯< 0.05). Patients with a combination of the factors "preoperative impairing pain" and "high pain expectation" showed distinct postoperative pain with NRSâ¯> 4 significantly more often (59.4%, pâ¯< 0.001). These findings could be demonstrated for the departments general surgery, plastic surgery and trauma surgery. CONCLUSION: The combination of both risk factors results in a unique risk group for the appearance of strong postoperative pain. This group can be economically determined in the daily clinical routine using the Lübeck Pain Risk Questionnaire. Further studies must be carried out to show if additional perioperative procedures can be profitable for the risk group identified with the Lübeck Pain Risk Questionnaire; however, patients falling outside the risk group must not be neglected because they too can develop severe postoperative pain.
Motivation , Pain, Postoperative/psychology , Adult , Aged , Female , Humans , Male , Middle Aged , Pain Measurement/methods , Pain Measurement/psychology , Risk Factors
OBJECTIVE: the German guideline for the treatment of acute perioperative and post-traumatic pain (S3-Leitlinie zur Behandlung akuter perioperativer und posttraumatischer Schmerzen) recommends giving preoperative information about postoperative pain and how to influence it. It is expected that the effect of preoperative information is modified by psychological characteristics of the patient. One of these psychological characteristics is the individual coping style. The purpose of the study is to evaluate whether or not patients benefit from preoperative education in relation to their level of negative coping style. METHODS: the study is based on a 2×2 factorial experimental design with the experimental factor "treatment" (education vs control condition) and the factor "negative coping style" (high vs low). After informed consent 96 patients undergoing abdominal or vascular surgery were enrolled in the study. Outcomes were pain intensity, pain quality and psychic state. They were assessed by using numerical rating scales and psychometric methods of self-assessment. The data were collected preoperatively and on the first to third postoperative day. RESULTS: patients who received preoperative education experience a greater reduction in postoperative pain than patients without preoperative education do (ES=0.48). The risk for stronger pain (NRS>3) on the third postoperative day is decreased (2.1 vs 14.6%). The influence of negative coping style is altogether minimal. CONCLUSIONS: preoperative patient information has positive effects on the postoperative development of pain. Patient information is a valuable addition to the drug pain treatment. The application can be recommended regardless of the level of the patients' negative coping style.
Adaptation, Psychological , Digestive System Surgical Procedures/psychology , Individuality , Pain, Postoperative/psychology , Patient Education as Topic/methods , Preoperative Care , Vascular Surgical Procedures/psychology , Adult , Aged , Female , Humans , Male , Middle Aged , Pain Measurement/statistics & numerical data , Personality Inventory/statistics & numerical data , Practice Guidelines as Topic , Psychometrics , Wounds and Injuries/psychology , Young Adult
Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.
Back Pain/epidemiology , Adolescent , Back Pain/etiology , Back Pain/psychology , Child , Humans , Life Style , Risk Factors
At present there is hardly any appropriate therapy for central pain syndromes available. We report on a unique case of a central thalamic pain syndrome that did not respond to any therapy but disappeared after an additional contralateral parietal lobe lesion. This example indicates that lesions affecting the bilateral balance of thalamo-parietal circuits may lead to pain relief in patients with central pain syndrome, which probably constitutes a bilateral disorder of functional plasticity. This should be taken into account in chronic brain stimulation for persistent pain states.
Electric Stimulation Therapy/methods , Pain Management , Parietal Lobe/pathology , Thalamus/pathology , Humans , Male , Pain/pathology , Pain Threshold/physiology , Parietal Lobe/physiology , Syndrome , Thalamus/physiology
INTRODUCTION: Testing the validity of the Mainz Pain Staging System (MPSS) is often carried out by pain classification according to chronic stage. It is assumed that pain syndromes distribute equally over the chronic stages. This analysis was carried out to answer three questions: Do different pain syndromes vary in chronicity, do the four axes of the MPSS differ between pain syndromes, and are there any specific item responses with respect to a pain syndrome? METHODS: 406 patients with different pain diagnoses were included in this analysis. Patients were chosen from the PAIN-Documentation-System of the pain outpatients' department of the Medical University of Luebeck. The pain score according to MPSS had been assessed, and a diagnosis attributed according to the Multidimensional Classification of Pain (MASK). RESULTS: Pain diagnoses do differ in pain chronification. Patients with headache showing the lowest chronification, and patients with back pain describing the most severe chronification, formed the extreme patient groups. Further analysis using the axes of the MPSS demonstrate different sensitivity with respect to pain syndromes, i. e. intake of drugs being the least sensitive and aspects of time being the most sensitive axes. Statistical analysis using configural frequency analysis indicated a relation between pain syndromes and specific item responses. CONCLUSION: Using pain stages of the MPSS as an experimental factor in studies of pain, it is imperative either to control pain syndromes or to confine to a single pain syndrome, to avoid confusion between pain syndromes and severity of pain chronification.
Pain Measurement/methods , Pain/physiopathology , Chronic Disease , Diagnosis, Differential , Germany , Humans , Middle Aged , Models, Neurological , Pain/classification
BACKGROUND: The individual experience of postoperative pain values considerably. It is the patient who can best evaluate the intensity of pain and the effect of a given analgesic substance. Patient-controlled analgesia (PCA) enables the patient to self-administer an i.v. analgesic bolus by pressing a button of an electronic pump device within a previously set range. If needed. The resection of rib cartilage to be used for ear reconstructions is associated with intense postoperative pain. This could result in unfavorable stress responses such as impaired cough and clearance of lung secretions carrying a greater risk of bronchitis or pneumonia, prolonged mobilization, and complications of wound healing. Therefore, individually adapted pain therapy is of great importance and technically feasible with modern PCA devices. METHOD: Informed and cooperative children aged five years and older and adults without severe health risks are suitable for PCA. Management, handling, monitoring and documentation of the PCA device are discussed. A 24-hour counselling service is maintained for occurring problems. RESULTS: Almost all patients expressed their great satisfaction with the means of pain therapy. Few patients were apprehensive. The initial scepticism of the involved personnel concerning opioid abuse, over-dosage, or technical problems gave way for a support of the PCA once the great satisfaction of the patients in absence of side effects was witnessed. No patient had to be antagonized for respiratory depression. Nausea and vomiting were rare events. CONCLUSION: Patient-controlled analgesia proved to be an excellent answer to postoperative pain after resections of rib cartilage.
Analgesia, Patient-Controlled/instrumentation , Cartilage/transplantation , Ear, External/surgery , Pain, Postoperative/drug therapy , Adult , Child , Documentation/methods , Equipment Design , Humans , Pain Measurement , Software
Following a traumatic lesion of the brachial plexus, severe pain syndrome in the left shoulder and arm developed in a 42-year-old patient. The pain could not be relieved by multiple therapeutic attempts. Therefore, electrocoagulation of the substantia gelatinosa was performed on the affected side of the evulsed plexus from the dorsal aspect of the cervical spinal cord (Dorsal-Root-Entry-Zone-Lesion, DREZ-operation). After temporary relief, the initial pain syndrome returned. Intravenous salmon-calcitonin infusions administered at our pain clinic led to almost complete remission of pain. Six months later the original symptoms returned and therefore the same infusion scheme was repeated with identical results.
Calcitonin/therapeutic use , Electrocoagulation , Pain, Intractable/therapy , Spinal Nerve Roots , Calcitonin/administration & dosage , Humans , Injections, Intravenous , Male , Middle Aged , Pain, Intractable/drug therapy
We considered it useful to attempt to diagnose fetal distress or fetal heart failure in hydropic fetuses using external electrodes with a feto-maternal electrocardiographic machine. The pathological tracings that we obtained have been compared with tracings from a normal pregnancy. The authors have not been able to find that there is a significant difference between the electric axes of normal fetuses and pathological fetuses. In fact in both groups we have found as many normal axes with right deviation as with left deviation. In any case we have found that low voltage ventriculograms with a triangular shape have been more common in hydropic fetuses than in the control group. We do not think that this method will be of any use in diagnosing chronic fetal distress of heart failure. All the same we think that we should devote our attention particularly to those patients that have low voltage ventriculograms of triangular shape. We would like to thank Dr Mario Villamichel for his advice and commentary on the manuscript as well as Dr Luis Senties, the Chef de Service of the Department of Isoimmunisation.
Electrocardiography/methods , Erythroblastosis, Fetal/diagnosis , Fetal Heart , Edema/etiology , Female , Fetal Diseases/diagnosis , Fetal Distress/diagnosis , Fetal Distress/etiology , Humans , Infant, Newborn , Pregnancy , Rh-Hr Blood-Group System
