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Biomedical subjects

I Gralow

Publications and source records attributed to I Gralow.

17 recordsLinked to original sources
PubMed2006

[Pain therapy in addicted patients].

Each individual is entitled to an adequate and sufficient pain therapy. However, only a few studies have examined the peculiarities of pain management in drug-dependent or formerly addicted patients. Any addiction is disadvantageous for a successful pain therapy, since some of the prescribed drugs may themselves cause addiction. Drug-dependent patients are often tolerant to opioids. Additionally, there is a risk of iatrogenic pain becoming chronic due to disregard for already known risk factors and comorbidities. However, a history of addiction should not prevent sufficient pain therapy, especially since there is no risk of addiction when the pain therapy employed is adequate for the pathophysiology involved. There are adequate pain therapies for addicted patients. The best results are achieved by taking into account the physiological and psychological peculiarities of drug-dependent patients. Importantly, this should be combined with a variety of different, optimized, multimodal therapeutic regimes, as well as with an interdisciplinary approach.

Acupuncture Therapy↗
PubMed2005

[Requirements for an interdisciplinary lecture on pain. Results from a survey of medical students].

BACKGROUND: Pain therapy is not an obligatory subject of undergraduate medical education in Germany. METHODS: In order to evaluate the expectations of undergraduate medical students regarding pain therapy as a lecture, a questionnaire was distributed to students visiting a faculty lecture on pain therapy. RESULTS: The main topics voted by the students as very interesting to them were pain syndromes such as low back pain, headache, and cancer pain. Furthermore, pharmacotherapy and the structure of pain therapy units were voted as interesting. Female students were significantly more interested in pain problems of specific patient groups (women, children, older patients, HIV-infected patients). Case reports on paper or with patient presentations were regarded as the most important didactic elements of such lectures. CONCLUSIONS: An analysis of the published undergraduate curricula in pain therapy revealed that the curriculum of the IASP and of the EFIC are too long and too theoretical, respectively. The curriculum of the DGSS meets many expectations of the students in this survey. Concepts of pain therapy education in undergraduate medical schools should consider the wishes of students regarding knowledge of pain syndromes and didactic methods.

Back Pain↗
PubMed2000

[Psychosocial aspects of chronic low back pain].

UNLABELLED: In many patients with chronic low back pain, no close correlation is found between the objective physical impairment and the subjective intensity of pain or the resulting disability. The process of chronification is the result of a complex interaction between somatic and psychosocial factors, as many epidemiologic and clinical studies could proof. DISCUSSION: Currently, these results are still neglected in clinical practise of diagnosis and therapeutic concepts.

English Abstract↗
PubMed1999

[Psychosocial handicap due to chronic headaches. Evaluation of the inventory of Disabilities caused by Headache].

Chronic primary headache has a considerable impact on the quality of life. To date, this impact has been evaluated by measurements of the general pain specific impairment of the quality of life. Headache specific measurements of quality of life or of disability caused by the headache are still missing for the German language. In America, a headache specific questionnaire, the "Headache Disability Inventory" (HDI), has been evaluated which is used in the presented study to create a German version, the "Inventar zur Beeinträchtigung durch Kopfschmerzen" (IBK). 94 consecutive patients with a primary headache disorder (59 female, 35 male; mean age 40 +/- 12 years) were examined. Cronbach's alpha was a = 0.90, the test-retest-reliability after three months was r = 0.87. An analysis of subscales for emotional and functional disability showed similar values for the internal consistency and the test-retest-reliability of these subscales. The scores of the different headache types did not differ significantly. In post-hoc-analyses, however, cluster headache showed higher disability scores than migraine both in the total scale and in the subscales. The total score of the IBK was significantly correlated with the number of headache days per month (r = 0.41; p < 0.0003) but not with the duration of disease or other demographic parameters. The IBK is the first German headache specific measurement of certain aspects of the quality of life in chronic headache patients. It can be used in clinical settings to evaluate the current state of the patient or to monitor treatment and it can be used for scientific studies.

Adult↗
PubMed1999

Drug-induced headache: long-term results of stationary versus ambulatory withdrawal therapy.

Drug-induced headache is a well-known complication of the treatment of primary headache disorders, and its successful management is only possible by withdrawal therapy. However, it is unknown whether ambulatory or stationary withdrawal is the therapy preferred. We conducted a prospective study on the outcome of stationary versus ambulatory withdrawal therapy in patients with drug-induced headache according to the International Headache Society criteria. Out of 257 patients with the diagnosis of drug-induced headache during the study period, 101 patients (41 after ambulatory and 60 after stationary withdrawal therapy) could be followed up for 5.9 +/- 4.0 years. The total relapse rate after successful withdrawal therapy was 20.8% (14.6% after ambulatory and 25.0% after stationary withdrawal therapy, p < 0.2). The main risk factors for a relapse were male sex (OR = 3.9, CI = 1.3-11.6), intake of combined analgesic drugs (OR = 3.8, CI = 1.4-10.3), administration of naturopathy (OR = 6.0, CI = 1.2-29.3), and a trend to tension-type headache as the primary headache disorder (OR = 1.9, CI = 0.6-53.0). Our data suggest that neither the method of withdrawal therapy nor the kind of analgesic and other antimigraine drugs has a major impact on the long-term result after successful withdrawal therapy. Patients with risk factors according to our findings should be informed and monitored regularly, and combined drugs should be avoided. Furthermore, our data suggest that there is a need for research on individual psychological and behavioral risk factors for relapse after successful withdrawal therapy in drug-induced headache.

Adult↗
PubMed1996

[Family emotional climate of pain patients].

Personal clinical experiences in an interdisciplinary pain clinic and their integration into family interaction theories led to a concept of an explorative study of chronic pain patients. Therefore 32 patients and their spouses were investigated with the "family-environment-scale" (by Moos and Moos 1981, adapted by Schneewind et al. 1985). Most of the couples showed agreement with regard to familial solidarity, combined with few expressions of anger and conflict and low achievement orientation. The typical profile of these factors led to one group with the "positive-emotional family climate", in contrast to one group with the "normative-authoritative family climate". In addition, a potentially new factor was described as a so-called "symbiotic family climate". The latter constellation was on the one hand quite similar compared to the "positive-emotional climate", but differed on the other hand because of the small amount of structural control. The interference of these family climate profiles with the process of chronification for pain patients is discussed.

Adult↗
PubMed1995

[Pharmacokinetics of buprenorphine in subcutaneous administration].

UNLABELLED: In this study investigations were carried out on pharmacokinetics of buprenorphine after it had been applied subcutaneously. Up to now no pharmacokinetic data exist using this kind of application with relevant clinical doses. METHODS: With 6 patients, who had major general surgery under balanced anaesthesia, buprenorphine was given in a single subcutaneous injection of 5 micrograms/kg bodyweight for postoperative pain relief. Over a period of 48 hours the level of buprenorphine in blood plasma was measured. The analyses were done with a modified HPLC method with electrochemical detection which is able to achieve measurements as low as 40 pg/ml of plasma. The pharmacokinetic values were calculated with the "Topfit" pharmacokinetic computerised programme. RESULTS: Whereas the period of time (tmax) to reach peak plasma concentration (Cmax) after subcutaneous application is much longer than with other parenteral application forms, the plasma concentration levels tend to be similar after 20 minutes. The most important finding of this study is that the mean terminal half-life (t1/2c) of buprenorphine is 23 hours. However, the presently available data for other application forms in respect to terminal half-life did not produce the same results. This can be explained by the use of insufficiently sensitive analytical procedures and by too short periods of observation of 3 and 13 hours respectively, leading to values of t1/2c of 2 and 5 hours. CONCLUSIONS: These results indicate that the terminal half-life (t1/2c) of buprenorphine is much longer than had been supposed. It confirms clinical findings of sufficient pain relief by showing measurable uptake of buprenorphine after subcutaneous application.

Aged↗
PubMed1995

A day-care pain clinic--its possibilities and limitations in the treatment of cancer patients.

A day-care unit was established to extend facilities of the pain clinic. During its first 2 years of operation 79 patients with cancer-related pain have been treated. Most patients were admitted because of intractable pain but also suffered other symptoms mainly concerning the gastrointestinal and respiratory tract. For more than half of the patients and their families, psychosocial problems were also an important issue. The central aim of the pain management programme is to improve the quality of life of patients with cancer-related pain through appropriate drug based or anesthetic interventions. Control of other symptoms and counseling for both patient and family are an integral part of the holistic approach. The first initial clinical experiences show that the day-care unit provides a noticeable improvement in patient care and constitutes an excellent link between the out- and inpatient therapeutic possibilities.

Adult↗
PubMed1992

[Chronic pain].

Explore the source record for details and available documents.

Analgesia↗
PubMed1991

[Pain therapy in patients with gynecologic tumors. Analysis of ambulatory pain management].

In a retrospective study efficacy and side-effects of long-term pain management of 58 patients with gynaecological cancer were analysed. Pathophysiological changes of the underlying tumor determined the choice of pain therapy. In more than 90% sufficient analgesia was obtained with tolerable side-effects. When patients became unable to swallow oral medication or showed intolerable side-effects, continuous subcutaneous or epidural opioid administration by means of lightweight disposable infusors proofed to be an efficient alternative in pain therapy.

Analgesics↗
PubMed1991

[Conversation during regional anesthesia].

From the psychological point of view, regional anesthesia is something special because the patient experiences his operation consciously. This means that the anesthetist is required not only to guarantee a safe anesthetic, but also to recognize the special needs of the patients, to enter into them adequately, and thus to support the patient's own strategies for coping with his situation. The question arises as to what extent the anesthetist's behavior meets the patient's psychological requirements. For this reason, the conversation between patient and anesthetist was monitored during 17 operations under regional anesthesia and investigated by means of a quantitative speech analysis. It was shown that the anesthetist clearly predominated in the course of the conversation: particularly during the time when the patient was preparing himself for the operation, it was the anesthetist who actively framed the communication by numerous questions and conversational activities while the patient responsively remains passive. The anesthetist spoke simply and clearly to the patient. Prime consideration was given to explaining the anesthetic procedure and the operation. There were not many attempts by the physician to also deal with the patient's psychic state. On the while, communication was concerned with the quick and easy performance of anesthesia. This was also demonstrated by the fact that conversation between the anesthetist and the patient was nearly absent during the operation.

Anesthesia, Conduction↗
PubMedDate not supplied

Sumatriptan and ergotamine overuse and drug-induced headache: a clinicoepidemiologic study.

Drug-induced headache, particularly ergotamine-induced headache, is a common problem in migraine treatment. Some case reports suggest that even the new serotonergic antimigraine drugs such as sumatriptan can lead to overuse and subsequent drug-induced headache. We performed a controlled study to identify the rate of sumatriptan overuse and sumatriptan-induced headache and compared it to the rate of ergotamine overuse and ergotamine-induced headache. Two thousand sixty-five consecutive heachache patients, all experienced in intake of sumatriptan (n = 631) or ergotamine (n = 620), were enrolled over a three-year study period. The rates of overuse and drug-induced headache and the clinical features of the subgroups were compared. Risk factors for sumatriptan overuse were identified. The rates of ergotamine and sumatriptan overuse were 14.2% and 3.5%, respectively (p < 0.001). Drug-induced headache could be found more frequently in cases of ergotamine overuse than in cases of sumatriptan overuse (68% versus 32%; p < 0.01). Development of sumatriptan overuse was most common in patients with previous drug-induced headache (68%), combined headache as the primary headache type (45%), and subcutaneous application of sumatriptan (45%). We conclude that sumatriptan intake can lead to overuse and subsequent drug-induced headache. The risk for overuse and drug-induced headache is significantly lower than in patients with ergotamine intake. This might be caused in part by the relatively short period of sumatriptan availability on the market. The new generation of serotonin-1B/D-receptor agonists in the treatment of headache should have a potential for overuse similar to that of traditional headache drugs.

Adult↗
PubMedDate not supplied

[Pain treatment in advanced head and neck tumors. Pilot study with continuous subcutaneous administration of morphine].

In the pain treatment of patients with incurable head and neck tumors it may be difficult to provide adequate oral drug therapy in the advanced stages. In these cases continuous subcutaneous application of morphine by means of external infusors is an alternative. This mode of application was investigated in the long-term treatment of 20 patients with pain that had been therapyresistent until then. Producing sufficient analgesia and having, all told, comparable side-effects, this method was experienced by all patients as being more agreeable than the previously used oral mode of application. Technical simplicity of handling makes this safe and effective treatment concept also a valuable means for outpatient care in tumor clinics.

Female↗