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Biomedical subjects

M Zenz

Publications and source records attributed to M Zenz.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Postdural puncture headache: diagnosis, prevention and therapy].

Lumbar puncture (LP) is a routine technique performed for a variety of procedures, e.g. diagnosis, administration of drugs, myelography and spinal anaesthesia. Postdural puncture headache is a common complication (30-40% in diagnostic LP). Prevention can be accomplished by using small-gauge needles (< or = 25 G) or pencil-point needles (22 G). Therapy should be carried out in a stepwise approach. The first step is bedrest, use of analgetics, i.v. fluids and an adequate guidance of the patient. The second step comprises special drug therapy. Several methods of pharmacologic management have been presented in the literature, but most of these are case reports. There is a lack of large double-blind placebo-controlled studies. Theophylline, caffeine, ACTH and sumatriptan are potentially promising agents for the treatment of postdural puncture headache. The efficacy of theophylline has been proven in a double-blind and placebo-controlled study. There are a few studies and case reports reporting that caffeine p.o. and i.v. is effective in the treatment of postdural puncture headache, but recurrence of headache after caffeine therapy is frequent. ACTH acts on a complex hormonal system. The treatment with sumatriptan has been reported in only a few case reports. The third step, and one of the most effective treatments of postdural puncture headache, is the epidural blood patch. The success rate ranges between 80 and 97%.

English Abstract↗
PubMed1999

Influence of the N-methyl-D-aspartate antagonist memantine on human motor cortex excitability.

The aim of our study was to investigate the effect of the N-methyl-D-aspartate (NMDA) antagonist memantine on motor excitability in humans. Seven healthy volunteers received memantine or placebo, respectively, over a period of 8 days. At day 8, transcranial magnetic stimulation (TMS) was performed using a paired pulses paradigm in order to assess intracortical inhibition and facilitation. Additionally, motor threshold and silent period duration after TMS were measured as well as M waves, F waves and peripheral silent period after electrical peripheral nerve stimulation. Intracortical inhibition was enhanced, and intracortical facilitation reduced after memantine ingestion in comparison to placebo, whereas no significant difference could be observed regarding the other neurophysiological parameters. We conclude that the NMDA receptor is involved in the regulation of excitability of intracortical interneuronal circuits.

Adult↗
PubMed1999

[Coenesthesia--an important differential diagnosis in chronic pain syndromes].

BACKGROUND: Coenesthesias can be defined as disorders of body perception or body hallucinations, projected in different parts of the body. Patients complain of intractable pain or dysesthesia. These symptoms are reported even from organs where we usually have no perception. Coenesthesia must be regarded as a symptom that can be observed in various psychiatric diseases, e.g., schizophrenia. However, in rare cases coenesthesias can be documented in neurological diseases, e.g., intracranial tumors or infections. Therefore, accurate assessment of possible differential diagnoses is important. In late stages, coenesthesias can easily be recognized because of their "bizarre" character. In early stages, however, patients often complain of intractable, unlocalizable burning pain. They frequently undergo operations because of their great suffering. The drug treatment of first choice is neuroleptics, but the results are unpredictable. CASES AND THERAPY: The case studies of three patients are presented and discussed (patient 1 with coenaesthetic schizophrenia, patient 2 with coenesthesia in the course of a delusional (paranoid) disorder; patient 3 with coenesthesia caused by carcinomatous meningitis).

English Abstract↗
PubMed1999

[Pharmacist's attitudes towards opioid prescription].

UNLABELLED: The prescription of strong opioids underlies a special legislation. The attitude of the pharmacists towards the long-term treatment with these analgesics and their opinion about the legislation is unknown in Germany and other European countries. METHODS: A questionnaire was included in the Journal "Mitteilungsblatt der Apothekerkammer Westfalen-Lippe" and send to all 2300 pharmacists of the region Westfalen-Lippe in December 1997. RESULTS: 797 (35%) questionnaires were returned. In 82.4% of the pharmacies strong opioids are kept in stock. However, 140 pharmacists do not have opioids in stock due to too many different preparations or low prescription rate. 54% of the pharmacists warn their patients about endangering by the medication. The fear of psychological addiction (48.1%) is the main argument, also in patients with regular intake of the opioids (20.1%) and related to long acting opioids (10.8%). Nevertheless, 73% of the pharmacists advocate for a liberalization and 10.7% for an abolishment of the actual prescription laws. DISCUSSION: The importance of the therapy with strong opioids is well accepted by the pharmacists. An ease of the prescription is demanded to improve the situation of the patients with chronic pain. However, the majority of the pharmacists warns the patients about this medication. Contact between prescribing doctors and pharmacists and an intensified education concerning the therapy with opioids are needed in addition to the education of the medical staff and the liberalization of the prescription laws.

English Abstract↗
PubMed1999

[Posttraumatic pain. Causes and therapeutic possibilities].

Each patient has the right of a dedicated pain therapy according to the state of the art. However an efficient pain therapy is not possible without knowing the cause of pain. In most posttraumatic pain situations peripheral nociceptors are activated and normal afferences are conducted via an intact nociceptive system. In contrast, neuropathic pain pain is caused by lesions of the nervous system itself. Mechanisms of central sensibilization and involvement of the sympathetic nervous system may lead to chronification of such pain conditions. The therapeutic regime of nociceptive and neuropathic pain is demonstrated by algorithms of treatment modalities. Apart from classic non-opioid analgesics, co-analgesics and opioids have an important status in chronic pain management as well. Prescription of these substances has to follow strictly defined standards of pain therapy. Blockades with local anaesthetics as mono-therapy of chronic pain are obsolete. In posttraumatic pain, however, a certain number of adjuvant blockades or infiltrations of triggerpoints may be helpful. The exceptional place of sympathetic blockades are in diagnosis and therapy of sympathetic maintained pain (SMP).

Ankle Injuries↗
PubMed1999

Hemisensory impairment in patients with complex regional pain syndrome.

The purpose of the present study was to investigate the extent and quality of sensory impairment and their relation to pain characteristics and movement disorders in patients suffering from complex regional pain syndrome (CRPS) type I. Neurological testing was performed independently by two examiners in 24 patients with CRPS type I. In eight patients (33%), a hemisensory impairment with decreased temperature and pinprick sensation ipsilateral to the limb affected by CRPS could be observed. In four patients (17%), a sensory deficit in the upper quadrant of the body could be demonstrated and in eight patients (33%), sensory impairment was limited to the limb affected by CRPS. Mechanical allodynia and mechanical hyperalgesia could be observed in a higher percentage of patients with hemisensory deficit or sensory impairment in the upper quadrant (92%), than in those patients with sensory impairment limited to the affected limb (17%) (P < 0.005). In patients with left-sided CRPS, sensory abnormalities in the upper quadrant or hemisensory impairment were more frequently demonstrated (77%) than in patients with right-sided CRPS (18%) (P < 0.005). There was a high correlation (92%) for the sensory findings between the two examiners, and hemisensory abnormalities were stable over a period of 3-6 months in all six patients with repeated examinations. Motor impairment (contractures, weakness, tremor or difficulties in initiating movement) could be observed in a higher percentage in patients with sensory abnormalities in the upper quadrant or hemisensory impairment (83%) than in patients with sensory impairment limited to the affected limb (42%) (P < 0.05) and was significantly correlated with allodynia/hyperalgesia (P < 0.005). The results demonstrated that sensory deficits in patients with CRPS, frequently extend past the painful area of the affected limb. The increased frequency of mechanical allodynia and movement disorders in patients with hemisensory impairment or sensory deficits in the upper quadrant, might indicate that central mechanisms are involved in the pathogenesis of CRPS in these patients.

Adult↗
PubMed1998

[Staged analgesic therapy in tumor pain].

Overall, pain is one of the most common symptoms associated with cancer and often produces greater anticipatory distress than other features of the disease. Drug selection depends on the intensity of pain rather than on the specific pathophysiology. Mild to moderate pain can often be treated effectively by so-called "weak" opioids. Non-opioid analgesics, like acetyl-salicylic acid or paracetamol can be added according to the "analgesic ladder" proposed by the World Health Organization (WHO). Opioids should be given on a fixed time schedule thereby, preventing pain from recurring. Additional rescue doses (approximately 50 degrees, of baseline single dose) are given for breakthrough pain. Noninvasive (oral, rectal, sublingual, transdermal and intranasal) routes of application should be maintained as long as possible to preserve independence and mobility. When treatment by infusion therapy (subcutaneous, intravenous, epidural) has been elected, the addition of patient controlled analgesia (PCA), which permits patients to administer a preset amount of narcotic at preset intervals, is an effective means to manage breakthrough and incident pain in selected patients. Antidepressants, anticonvulsants and some antiarrhytmics are used as co-analgesics. Oral medication alone can guarantee pain relief in about 95% of the patients. The WHO analgesic ladder has proven effective in all settings of patients care.

Analgesics↗
PubMed1998

Vespula vulgaris venom: role of kinins and release of 5-hydroxytryptamine from skin mast cells.

Wasp venoms contain several active components, among them kinin-related peptides. Like bradykinin and [Thr6]bradykinin, Vespula vulgaris venom caused paw oedema following subplantar injection in anaesthetized rats. The oedema was partly inhibited by the bradykinin B2 receptor antagonist icatibant (Hoe 140); the remaining part was abolished by additional pretreatment with 5-hydroxytryptamine (5-HT) receptor antagonists or mast cell depletion. Histamine receptor antagonists were ineffective. Capsaicin pretreatment attenuated oedema formation indicating a neurogenic sensory component. Nociceptive behavioural responses induced by the venom in unanaesthetized rats were abolished by icatibant. It is concluded that kinins, either contained in the venom or released from the tissue, play the predominant role in the inflammatory and algesic effects. The inflammatory effects only partly rely on direct, bradykinin receptor-mediated mechanisms while the remaining part depends on the release of 5-HT from skin mast cells. The algesic effects of the venom are entirely due to direct B2 receptor activation.

Animals↗
PubMed1998

[A survey of physicians' knowledge about pain therapy with strong opioid analgesics].

INTRODUCTION: The WHO analgesic ladder, including the use of strong opioid analgesics for the treatment of cancer pain, is widely accepted. However, the use of opioids for the treatment of non-cancer pain is still controversial. This study investigates doctors' medical knowledge about basic aspects of pain management. Additionally, we determined whether the deficiencies in the treatment of patients suffering from pain are based on the rigorous national narcotic control system in Germany. METHODS: We investigated the juridical and technical knowledge of physicians specializing in pain therapy by a questionnaire. During a postgraduate course the knowledge about pain therapy according to the WHO analgesic ladder and the beliefs concerning the narcotic regulations in Germany were evaluated. The survey participants were asked to rate their attitudes on a 10-point analogue scale (1=disagreement, 10=full agreement). The participants were also asked to indicate occupational criteria such as specialty, clinical practice area, and postgraduate years of practice. Descriptive statistics for the mean values were used. RESULTS: One hundred and forty-three questionnaires were completed. The majority of participants worked at departments of anaesthesiology. Some 51.1% of the participants had no specific multiple-copy prescriptions for opioid analgesics. Only 72% of the physicians knew from which governmental institution they could order multiple-copy prescriptions. In general, more doctors would prescribe opioids by the use of normal forms. The controlled substance laws were seen as an impediment by the majority of participants, without relevant differences as to their years of practice. The regulations were regarded as ineffective protection against illegal use of opioids. Treatment of pain with strong opioid analgesics was seen as beneficial for the patients. The use of strong opioids for long-term treatment was recommended, and psychological addiction was regarded as non-existent. CONCLUSION: Therapy with strong opioids is accepted practice, but significant deficits of legal and technical knowledge uphold the undertreatment of patients suffering from cancer and non-cancer pain. Patients with a legitimate need for pain relief by strong opioids are the unintended victims of tight narcotic regulations and deficits in medical education. An ease of regulatory conditions is mandatory to reduce the reluctance for prescribing opioids. On the other hand intensified continuous medical education is mandatory to reduce the undertreatment of patients with severe pain conditions.

English Abstract↗
PubMed1998

[Are tramadol enantiomers for postoperative pain therapy better suited than the racemate? A randomized, placebo- and morphine-controlled double blind study].

The goal of this prospective, randomised and double-blind pilot-study was to investigate the analgesic potency and the side-effects of tramadol enantiomers in clinical practice. One hundred patients recovering from orthopaedic surgery with a postoperative pain intensity of more than 50 on a visual analogue scale 0-100 mm (Table 1) were recruited for the study. They were treated in a randomised, double-blind way with a maximal dose of 150 mg i.v.(+)-,(-)-tramadol, racemate, or 15 mg i.v. morphine or saline in the placebo group (5 groups, 20 patients each). The primary criterium of efficacy was the number of responders defined as patients with a pain reduction of at least 20 on VAS after 40 min. In case of pain, responders were allowed to continue with the double-blind drug up to six hours. The non-responders were treated with morphine as the rescue analgesic. The secondary criterium was the incidence and severity of side-effects. Six patients terminated the study prematurely. One patient was excluded because of an allergic reaction to morphine, one patient could not be treated sufficiently with morphine, four were excluded because of protocol violations. There were 8 responders in the (+)-tramadol-,6 in the (-)-tramadol- and 6 in the racemate group, 16* (P < 0.05) in the morphine group, and 5 in the placebo group. Pain intensity after 40 min was reduced by 20 (p < 0.05), 17 (p < 0.05), 17 (p < 0.05), 36 (p < 0.01 vs placebo, p < 0.05 vs (+)-,(-)-tramadol, and racemate group) and 5 mm on the VAS in the (+)-, (-)-, (+/-)-tramadol-, morphine- and placebo-group, respectively. Thirty eight adverse events like nausea, vomiting, PCO2-increase, and urinary retention occurred in 20 patients, most frequently in the (+)-tramadol- and morphine group. Sedation was significantly less profound in the (-)-tramadol group 1-4 h postoperatively. There were no side-effect in the tramadol racemate group. The enantiomers were equal to the racemate in analgesic potency, but inferior by far to morphine. They showed more adverse events and, hence, can not be preferred to the racemate in postoperative pain therapy.

Analgesics, Opioid↗
PubMed1998

Long-term treatment of cancer pain with transdermal fentanyl.

The long-term therapy of 51 patients using transdermal fentanyl was evaluated. The transdermal therapy was performed for 158 days (range, 15-855 days). The need for increasing dosages of transdermal fentanyl was caused by the progression of the underlying cancer disease (mean initial dose, 69.5 micrograms fentanyl/hr; mean final dose, 167.7 micrograms fentanyl/hr). The transdermal system was changed every third day. Application intervals had to be shortened in 23.5% of the patients. Pain reduction was good throughout the study. Severe side effects did not occur. Constipation and the need for laxatives occurred less frequently than with previously administered oral morphine. Skin tolerance of the transdermal system was good. The treatment of cancer pain with transdermal fentanyl can be performed as a long-term therapy and result in good pain relief. Considering its specific pharmacokinetic properties, it is an alternative medication on step III of the World Health Organization's guidelines for cancer pain management.

Administration, Cutaneous↗
PubMed1998

Experiences with the prescription of opioids: a patient questionnaire.

Forty-three German patients who had been treated with strong opioids were questioned about their experiences during therapy. The prescription of opioids was well accepted by most patients. Some, however, felt stigmatized by taking opioids. Fourteen patients (33%) were asked by their relatives, friends, or other patients about the special prescription form. Six patients (14%) had difficulties in redeeming the prescription at the pharmacy, seven patients (16%) were warned against taking the medication by the pharmacist, 21 patients observed that their general practitioner (GP) was mistrustful about the treatment, and 16 patients (37%) reported that the GP terminated the therapy. Despite the beneficial effect for the patient, opioid treatment started and supervised in a pain clinic is not always continued by the GP. In Germany, it may not be possible to administer opioid therapy outside of a specialized pain clinic. In those few cases in which an opioid therapy is successfully instituted, difficulties continue due to prejudices, insufficient education, and complicated prescription laws.

Adult↗
PubMed1998

Pain therapy.

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Journal Article↗
PubMed1998

Long-term effects of nerve blocks in chronic pain.

Regional blockade techniques have been of crucial importance for decades in chronic pain therapy, but in recent years some developments have made a new definition of the status of invasive procedures necessary. The realization of chronic pain as a multifactorial process led to the establishment of an interdisciplinary approach to pain therapy, leaving blockades as only one step in a multimodal therapy. The mainstay of local anaesthetic blocks now is diagnostic and prognostic, but correct interpretation of the results is limited by different factors, and controlled studies on the diagnostic value of local anaesthetic blockade are lacking. In cancer pain, invasive procedures are necessary in only a few cases. Some neuroablative techniques can offer long-term pain reduction. In non-cancer pain, neurodestructive procedures should be reserved for some special indications (e.g. lumbar sympathetic neurolytic blocks in ischaemic diseases). In a great number of chronic pain conditions the sympathetic nervous system is involved or even has a central status. In the acute stage of these diseases sympathetic blockades can be the therapy of choice. There is no disease in which different invasive procedures are performed so frequently and so uncritically as in chronic low back pain. Up to now, however, all controlled studies of invasive procedures only demonstrated short-term effects and failed to prove long-term efficacy. Therefore any invasive technique should only be performed in well-selected patients over a defined period and with a limited number of blockades.

Journal Article↗