[Patient perspectives in outcome research : Development of a focus group concept for collating patient perspectives on determination of effectiveness of multimodal pain therapy - A pilot study]. / Patientenperspektive in der Outcomeforschung : Entwicklung eines Fokusgruppenkonzepts zur Erhebung der Patientenperspektive auf die Effektivitätsbestimmung der multimodalen Schmerztherapie ­ eine Pilotstudie.

BACKGROUND: To assess the efficacy of multimodal pain therapy for chronic pain patients it is necessary to use suitable outcome domains as well as reliable and valid measurement instruments. Using pain intensity as an example, however, it is shown that there are critical issues with respect to suitability for chronic pain patients and the quality (e.g. content validity, feasibility and interpretability) of commonly used measurement instruments. METHOD: A focus group concept was designed to discuss the construct of pain intensity and common measurement instruments with chronic pain patients who underwent multimodal pain therapy. The focus group concept was tested in two pilot groups (N = 10) where eight issues previously established in guidelines were discussed. RESULTS: The results of the pilot studies affirmed that the construct of pain intensity as well as the measurement instruments must be critically considered when applied to chronic pain patients and the effectiveness of multimodal pain therapy. The concept of patient focus groups proved to be a suitable method for patient participation. Integrating patients should be considered not only in discussions of existing pain scales but also in developing new measurement instruments.

[Chronic non-cancer-related pain. Long-term treatment with rapid-release and short-acting opioids in the context of misuse and dependency]. / Chronische nichttumorbedingte Schmerzen. Langzeitbehandlung mit schnell freisetzenden und kurz wirksamen Opioiden im Kontext von Missbrauch und Abhängigkeit.

Annually published data show a continual increase in the volume of opioid prescriptions in Germany, thus indicating an intensification of opioid therapy. The majority of opioids are prescribed to treat chronic non-cancer-related pain. On the basis of current guidelines, as well as in terms of the lack of data regarding long-term use of opioids and their effectiveness beyond a period of 3 months, this development must be viewed critically. With reference to four case reports, we discuss and evaluate opioid therapy in relation to medication misuse and the development of drug dependency. Particular emphasis is placed on the administration of rapid-release and short-acting opioid preparations, which we consider to be particularly problematic.

Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design.

BACKGROUND: Despite intensive research, the main causes of postoperative nausea and vomiting (PONV) remain unclear. We sought to quantify the relative importance of operative, anaesthetic and patient-specific risk factors to the development of PONV. METHODS: We conducted a randomized controlled trial of 1180 children and adults at high risk for PONV scheduled for elective surgery. Using a five-way factorial design, we randomly assigned subjects by gender who were undergoing specific operative procedures, to receive various combinations of anaesthetics, opioids, and prophylactic antiemetics. RESULTS: Of the 1180 patients, 355 (30.1% 95% CI (27.5-32.7%)) had at least one episode of postoperative vomiting (PV) within 24 h post-anaesthesia. In the early postoperative period (0-2 h), the leading risk factor for vomiting was the use of volatile anaesthetics, with similar odds ratios (OR (95% CI)) being found for isoflurane (19.8 (7.7-51.2)), enflurane (16.1 (6.2-41.8)) and sevoflurane (14.5 (5.6-37.4)). A dose-response relationship was present for the use of volatile anaesthetics. In contrast, no dose response existed for propofol anaesthesia. In the delayed postoperative period (2-24 h), the main predictors were being a child (5.7 (3.0-10.9)), PONV in the early period (3.4 (2.4-4.7)) and the use of postoperative opioids (2.5 (1.7-3.7)). The influence of the antiemetics was considerably smaller and did not interact with anaesthetic or surgical variables. CONCLUSION: Volatile anaesthetics were the leading cause of early postoperative vomiting. The pro-emetic effect was larger than other risk factors. In patients at high risk for PONV, it would therefore make better sense to avoid inhalational anaesthesia rather than simply to add an antiemetic, which may still be needed to prevent or treat delayed vomiting.