Michael Brinkers

Misoprostol as a Therapeutic Option for Trigeminal Neuralgia in Patients with Multiple Sclerosis

Dear Editor, Trigeminal neuralgia (TN) is characterized by attacks of recurring, paroxysmal, shock-like pain within the distribution of one or more branches of the trigeminal nerve [1]. About 2% of all TN patients have multiple sclerosis (MS); similarly, about 2% of all MS patients present with TN symptoms [2]. The combination of TN and MS is one of the rare, so-called “symptomatic” forms of TN. We present three cases of “therapy-resistant MS-related” TN, in which misoprostol therapy was successful. Case 1 reports of a 65-year-old female patient with a 32-year history of MS and a 4-year history of TN (V2 only). Further findings were a hemiparesis and hemiplegia lasting 1 year and a history of hypertension. She was suffering from pain attacks with a visual analog scale (VAS) of 10/10, which made eating impossible. The bouts appeared 20 times per day and lasted approximately 10 minutes. During the neurological follow-up, she received carbamazepine (CBZ) and nutrients parenterally. Increasing the doses of CBZ caused complications such as intermittent hyponatremia and hypocalcemia. She received additional administrations of 3–4 × 10 mg/day morphine subcutaneously. As the pain attacks persist, the medication was broadened to baclofen 4 × 5 mg/day, morphine retard 3 × 10 mg/day, and gabapentin at …

The general importance of antidepressants in treatment of patients with chronic pain

In recent years it came to a change of paradigm in therapy of chronic pain. Not the one cause is now responsible for a defined pain but a group of factors. According to this pain will be no longer treated with opioids or NSAIDs only but by given psychotropic drugs. To understand the following explanations you don?t need any special psychiatric knowledge. The present review tries to give anaesthesiologists a better understanding of antidepressants and to facilitate the application of the drugs.

Schmerzbehandlung bei Patienten mit schizoaffektiver Psychose und Tumor

ZusammenfassungEs wird über zwei Patienten mit schizoaffektiver Psychose, Tumor und entsprechender Schmerzsymptomatik berichtet. Da eine kausale Zuordnung der Schmerzen allein zur somatischen oder psychischen Störung nicht möglich war, konnte nur eine vorhergehende Therapieoptimierung der schizoaffektiven Psychose in Kombination mit Opioiden erfolgreich sein.AbstractWe report on two patients with schizoaffective psychosis, cancer, and pain. However, it is not possible to make somatic or psychic disturbances alone responsible for the pain. In patients with current schizoaffective disorders, only administration of a combination of psychopharmaceutical and opioid agents is successful.We report on two patients with schizoaffective psychosis, cancer, and pain. However, it is not possible to make somatic or psychic disturbances alone responsible for the pain. In patients with current schizoaffective disorders, only administration of a combination of psychopharmaceutical and opioid agents is successful.

Deklaration von Helsinki zur Patientensicherheit in der Anästhesiologie – Teil 7: Postoperative Betreuung inklusive Schmerztherapie

Primary aspects of post operative care should include decisive and adequate treatment of pain. Accordingly, schemes based on international guidelines and in consensus with other departments of the university hospital were developed. Successful therapy includes resolute action on three levels: Instruction of physicians, including supervision. standardized approach based on a readily available algorithm. adherence to fundamental implications of pain therapy such as pain assessment, repeated consultations and observation of complications. Based on this concept, patient safety in anesthesia can be increased.

[Psychotropic drugs - The special importance of anticonvulsants and neuroleptics in treatment of patients with chronic pain].

Therapy by psychotropic drugs is bound to limited indications, which are partially changing. By an extent literary research in pubmed and Cochrane especially corresponding articles of the past 10 years were proofed. So antidepressants were continually seldom given to nociceptor pain. While on the other side anticonvulsants are to be given in the case of neuropathic pain of defined quality, it will be looked for new applications for these drugs. Particularly hitherto existing difficult indications as fibromyalgia were investigated as possible indication for anticonvulsants. At least neuroleptics can be used for very difficult, resistant and bizarre pains such as cenesthesias.

Psychiatric Disorders in Complex Regional Pain Syndrome (CRPS): The Role of the Consultation-Liaison Psychiatrist

Background Complex regional pain syndrome (CRPS) is a multifactorial disorder with complex aetiology and pathogenesis. At the outpatient pain clinic of Magdeburg University Hospital, all patients, without exception, are subject to permanent psychiatric care delivered by a consultation-liaison psychiatrist. In CRPS, psychological stabilization and treatment of the neuropathic aspects are equally important. The aim of this single-center retrospective study was to determine mental/psychiatric defects impairing pain processing at the time of investigation and show the effects of treating mental disorders and neuropathic pain with the same psychotropic drugs. Method On admission, the consultation-liaison psychiatrist examined the mental state of every patient in a semistructured interview according to AMDP (working group for methods and documentation in psychiatry). Due to the model of the Department of Anaesthesiology, we are able to compare the group of CRPS patients with all other outpatients treated for pain. Results The medical treatment of psychiatric dysfunction leads to an analgesic effect. Only every second CRPS patient had an additional psychiatric diagnosis, and 15.6% were diagnosed with depressive mood disorders and show a higher prevalence of depressive symptoms than the general population and exceed the mean for all patients treated in our pain clinic. Conclusions In neuropathies, treatment of the neuropathic pain has a modulating effect on mental disorders. As CRPS patients are frequently affected by depressions, and owing to the connection between depression and suicidal tendencies, patients should be seen by a consultation-liaison psychiatrist, and nonpsychiatrists should pay special attention to this patient group.

The Combination of Pain and Aggression - Two Impressive and Representative Case Reports

Background: It is widely accepted that manifestations of pain cannot be detached from the case history, accompanying diseases, and the individual medication profile. An indirect association between pain and aggression (due to psychosis) as a cause of administration of neuroleptics has not been described yet. Aim & method: Here we report the connection between treatment of pain and additional medication with a neuroleptic for patients with manifest aggression and psychotic background in two impressive cases. Course & outcome: Case 1: A 57-year-old male patient underwent surgery for an esophageal carcinoma. Since the second postoperative day, the patient has been given long acting morphine orally. After several days, the patient became verbally aggressive. As he was suffering from a depression, he was administered higher doses of neuroleptics. As a consequence, his pain and aggression were reduced significantly and permanently. Case 2: A 24-year-old male patient was surgically treated for colon carcinoma. He complained about abdominal pain. Under long acting tilidine 50mg, pain increased. Increasing dosage had no effect. However, intensity of pain (NRS 10) could only be reduced to NRS 2 by piritramide (7.5mg). Despite of the lack of psychotic disorders in the past the patient became verbally aggressive. Presuming a reactive psychosis, an administered neuroleptic reduced pain and aggression effectively and permanently. Conclusion: If administration of painkillers does not lead to an adequate reduction of pain in the patient, and if an accompanying psychosis is present or suspected, this can manifest as aggression, an additional administration of neuroleptics needs to be considered. *Corresponding author: Frank Meyer, Department of Surgery, Otto-von-Guericke-University Magdeburg, Germany, E-mail: Frank.Meyer@Medizin.Uni-Magdeburg.de

Stationäre medikamentöse Schmerztherapie bei Tumorpatienten: Effekte einer manualisierten Leitlinie für den Konsildienst eines Universitätsklinikums

Hintergrund und Fragestellung | Die medikamentose Behandlung spielt in der Therapie von Tumorschmerzen eine wesentliche Rolle. Ziel dieser Studie war es, die Effektivitat eines anasthesiologischen Konsiliardienstes in einem Universitatsklinikum zu untersuchen und die Qualitat dieser Behandlung bei Patienten eines tertiaren Zentrums zu charakterisieren. Die Untersuchung wurde als eine systematische, klinische, unizentrische Observationsstudie zur Reflexion des klinischen Alltags und zur Kontrolle der Behandlungsqualitat angelegt. Patienten und Methodik | Im Rahmen des Konsildienstes der Schmerzambulanz auf den Stationen werden auch Tumorpatienten medikamentos behandelt. Dabei erfolgen nicht nur einmalige Konsile je Patient, sondern Kontrolluntersuchungen, bis die Patienten mit der Schmerztherapie zufrieden sind. Es wurden sowohl die medikamentosen Therapien vor dem Erstkonsil als auch die eigenen Masnahmen in der Folge prospektiv dokumentiert. Fur den Zeitraum zwischen 01.01.2010 und 31.12.2012 wurden die Daten der Konsilscheine retrospektiv ausgewertet. Zur Beurteilung der Qualitat der medikamentosen Schmerztherapie am Universitatsklinikum Magdeburg wurde ein Vorher-Nachher-Vergleich erstellt (Chi2-Test, Exakter Test nach Fisher, McNemar-Test). Die Auswirkungen der Therapie-Umstellungen wurden mithilfe des WHO-Indexes quantifiziert. Dazu wurden als Parameter der erreichten Schmerzreduktion die entsprechenden Schmerz-Werte auf der visuellen Analogskala (VAS) aufgezeichnet. Ergebnisse | Es wurden n = 375 Tumorpatienten stationar behandelt. Die Umstellung der medikamentosen Therapie durch den anasthesiologischen Konsiliardienst fuhrte zu einem signifikanten Anstieg des WHO-Indexes von 6,37 ± 1,83 (Standardabweichung) auf 8,43 ± 1,47 (p Folgerungen | Die konsequente Anwendung bereits etablierter Leitlinien (WHO-Stufenschema) fuhrt zu einer qualitativen und mittels etablierter Indices (WHO-Index) auch objektiv messbaren Verbesserung und Effektivitatssteigerung der medikamentosen Schmerztherapie von Tumorpatienten im klinischen Alltag.

Schmerzbehandlung bei Patienten mit schizoaffektiver Psychose und Tumor@@@Pain therapy in patients with schizoaffective disorder and cancer

ZusammenfassungEs wird über zwei Patienten mit schizoaffektiver Psychose, Tumor und entsprechender Schmerzsymptomatik berichtet. Da eine kausale Zuordnung der Schmerzen allein zur somatischen oder psychischen Störung nicht möglich war, konnte nur eine vorhergehende Therapieoptimierung der schizoaffektiven Psychose in Kombination mit Opioiden erfolgreich sein.AbstractWe report on two patients with schizoaffective psychosis, cancer, and pain. However, it is not possible to make somatic or psychic disturbances alone responsible for the pain. In patients with current schizoaffective disorders, only administration of a combination of psychopharmaceutical and opioid agents is successful.We report on two patients with schizoaffective psychosis, cancer, and pain. However, it is not possible to make somatic or psychic disturbances alone responsible for the pain. In patients with current schizoaffective disorders, only administration of a combination of psychopharmaceutical and opioid agents is successful.

Der suchtkranke Patient in der Anästhesie – Patienten mit Benzodiazepin-abhängigkeit

Als Folge der demografischen Entwicklung wird sich der Anteil altere Patienten, die sich operativen Eingriffen unterziehen und anasthesiologisch betreut werden mussen, zunehmend erhohen. Der Verbrauch von Benzodiazepinen nimmt nachweislich mit steigendem Lebensalter zu und damit wachst auch die Gefahr der Abhangigkeit mit einem hohen Risiko an Nebenwirkungen wie kognitive Storungen, Delir und Sturzen. Eine langfristige Einnahme kann auch bei Niedrigdosierungen perioperative Entzugssymptome hervorrufen. Der vorliegende Artikel weist auf Besonderheiten und Komplikationen hin, die v. a. bei Patienten im hoheren Lebensalter mit einer kritischen Benzodiazepineinnahme verbunden sind.As a result of the demographic change, the proportions of elderly patients undergoing operations and anesthesia are increasingly important. The consumption of benzodiazepines evidently rises with increasing age. Associated with the increasing consumption in the elderly is the risk of cognitive impairment, delirium, falls and fractures. Also long-term benzodiazepine use in low-dose may induce perioperative withdrawal syndrome. The following article will present characteristics and complications accompanied by critical benzodiazepine use especially in the elderly patients.