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Biomedical subjects

A Willweber-Strumpf

Publications and source records attributed to A Willweber-Strumpf.

14 recordsLinked to original sources
PubMed2005

[Psychological abnormalities in patients with complex regional pain syndrome (CRPS)].

QUESTION: Do comorbid psychological disorders, dysfunctional pain processing, and psychosocial pain coping occur with complex regional pain syndrome (CRPS) and is a connection between clinical and psychological manifestations apparent? METHODS: In addition to securing information on case histories and performing clinical neurological examinations of chronic CRPS patients, the structured clinical interview (SCID), pain perception scale, and the Kiel Pain Inventory were employed. RESULTS: The structured clinical interview revealed evidence of a depressive episode in 65% of CRPS patients. Pain perception is similar to neuropathic pain syndromes and patient history revealed a slightly increased frequency of anxiety and affective disorders. Depressive syndrome occurred significantly more often in right-sided CRPS; otherwise, there were no significant correlations between medical history, clinical examination, and frequency of psychological disorders. However, CRPS patients with allodynia manifest clinical signs of special psychological distress. CONCLUSION: In chronic CRPS depressive syndrome frequently develops and psychological treatment can be recommended.

Comorbidity↗
PubMed2005

[Risk factors for substance abuse and dependence in opioid therapy for chronic noncancer-related pain].

Opioids are valuable analgesics, capable of providing pain relief and functional improvement not only in patients with cancer-related pain, but also in chronic noncancer-related pain patients. However, recent data have shown that the increasing prescription of opioids is associated with a rise in aberrant drug-related behaviour. The causes of this behaviour are multifactorial. Some pharmacotherapeutic, but in particular psychosocial risk and etiologic pain factors have been identified. The indication for the prescription of opioids must be very carefully weighed in the presence of any risk factors. In these cases the integration into a multimodal, interdisciplinary therapy programme is mandatory. A contractual agreement on the opioid therapy including goals, side effects, controls including urine drug testing and criteria to finish the opioid therapy are advisable. Assessment of the progress of therapy is based on the following factors: analgesic efficacy, adverse side effects, functional status and aberrant drug-related behaviour. In the absence of a successful opioid therapy, the treatment must be discontinued to avoid iatrogenic damage, substance abuse and illegal diversion. After discontinuation of the therapy, a comprehensive interdisciplinary re-evaluation is required.

Analgesics, Opioid↗
PubMed2005

[Safety-relevant performance of patients on chronic opioid therapy].

AIM: Is there a difference in performance and psychomotor function between patients on chronic opioid therapy and healthy controls and which factors influence the performance of the patients? METHODS: A total of 80 patients and 243 healthy controls were investigated with computer-based tests concerning concentration, coordination, reaction time, vigilance, and perception. RESULTS: The patients' results were worse in the test for concentration and better in the test for coordination than the results of the healthy controls. The results in the tests for reaction time, vigilance, and perception did not significantly differ between the two groups. Patients receiving an antidepressant in addition to the opioid were worse in the test for concentration than patients without antidepressant. Patients older than 50 years were impaired in four of five tests, and patients driving a car within the last 12 months had better results than patients without driving experience. Pain intensity, dose of opioid, mental feeling and side effects did not influence the results of the patients. CONCLUSION: Psychomotor function and performance are not inevitably impaired in patients receiving opioids for pain therapy, but the ranges in the results prevent general conclusions. Performance and driving ability must be evaluated individually.

Analgesics, Opioid↗
PubMed2005

[Long-term efficiency of opioid medication in patients with chronic non-cancer-associated pain. Results of a survey 5 years after onset of medical treatment].

UNLABELLED: A total of 121 patients with at least a 3-year history of opioid use were evaluated by a standardized interview during a clinical visit or telephone call. Assessed items were the present and former drug medication, daily doses, withdrawals, contentment with the treatment, positive/negative treatment effects, average/maximum pain and others. STATISTICS: chi(2), ANCOVA and survival analysis. Of 121 patients (frequency of withdrawal 14.8% mainly due to lack of efficacy) with an average treatment time of 66 months (37-105 months; 80,264 days; 87% more than 5 years), 103 (85%) still took an opioid step II or III according to the WHO analgesic ladder. Patients further treated in the pain clinic stopped significantly less frequently than patients treated by GPs or other non-specialised physicians (5 versus 23%). Patients with long-term opioid intake revealed significantly lower pain intensity and higher contentment with the pain management and achieved improvement (global, quality of life and physical state). Changes of opioid dosages during the 5 years were inconsistent (no change 33%, decrease 16%, slight increase 27%, high increase 19%). However, the number of patients with high dose increased from 6 to 23 due to significant loss of efficacy (proved in the morphine subgroup, p<0.05). The survey demonstrates a very low frequency of withdrawal in patients with long-term opioid medication after initial response without evidence for tolerance development, especially if their treatment is controlled in a pain centre.

Analgesics, Opioid↗
PubMed2000

[Epidemiology of chronic pain - an investigation in 5 medical practices].

BACKGROUND AND METHODS: The aim of this study was to get more information about the prevalence of chronic pain in different practices of home physicians. 900 patients of five different specialists (general medicine, internal medicine, neurology, orthopaedics, surgery) in the german town Bochum were investigated with a questionnaire about chronic pain. Chronic pain was defined as a continuous or intermittend pain of longer duration than six months. RESULTS: 36% (328 patients) of all investigated patients had chronic pain due to this definition, twice more women than men. The four most frequent localisations of chronic pain were the back, the head, the joints and the legs. 15% of the patients with chronic pain were retired or going to retire due to their chronic pain. Orthopaedics were the most frequent physicians visited in the past. Only 5% of the patients had a psychological therapy and only 1% were treated in a pain clinic. The primary treatment strategies of the chronic pain were physiotherapy and drug therapy. 30% of the patients did not have any pain relieve by the past treatment strategies. CONCLUSION: Patients with chronic pain are a frequent and important problem in practices of home physicians. The high frequency of patients with chronic pain in practices of specialists demonstrates the necessity of a special qualification also on this level of our medical system.

English Abstract↗
PubMed1998

[Psychological pain therapy].

Psychologic strategies for the treatment of chronic pain are an important component of the necessary multidimensional treatment for patients in chronic pain. These techniques including relaxation training, biofeedback, hypnosis and cognitive-behavioral therapy have demonstrated efficacy. The impact of these techniques is on the sensory aspect of pain and the psychologic distress and on the maladaptive coping mechanism people develop in response to pain. In Germany there are still several impediments for the consequent application of psychologic strategies for patients with chronic pain. These impediments and possible solutions are discussed.

Adaptation, Psychological↗
PubMed1998

[Economic aspects of pain therapy].

Chronic pain has an economic impact for the society and the patients suffering from chronic pain. The indirect costs of chronic pain (loss of productivity, social security payments) are higher than the direct costs (prevention, diagnosis and therapy). The indirect costs in the family are often underestimated. It is proven that in-patient and out-patient treatment in multidisciplinary pain centers are effective. In-patient treatment is more expensive. Multidisciplinary pain programmes increase the return-to-work-rate significantly. Further investigations are requested to uncover costs and outcome of different pain treatment methods.

Chronic Disease↗
PubMed1997

[Opioids and driving ability].

INTRODUCTION: Clinical observations of patients under oral opioid treatment suggest that the initially appearing central side effects such as sedation, dizziness or drowsiness decrease after a few weeks of treatment. However, it is still unclear whether long-term treatment with opioids impairs complex psychomotor functions such as driving a car. METHODS: Twenty patients on stable dosages of oral opioids were examined using a driving simulator. The patients were regular car drivers and not older than 70 years. Additionally, every patient had to complete a questionnaire for mental condition and vigilance and the "d II" letter cancellation task. Control groups tested in the same way were: patients before an elective operation after taking benzodiazepines for sedation, volunteers after alcohol consumption (0.80 per thousand ), physicians on call with less than 4 h of sleep and healthy volunteers without any medication. RESULTS: Some of the patients treated with opioids reacted as fast as medication-free volunteers. There were no significant differences between the reaction times of older patients (>50 years) receiving opioids in comparison to the group of older healthy volunteers. The same result was obtained in the letter cancellation task. No differences could be seen between medication-free volunteers and patients receiving opioids with regard to tasks of visual or motor control skills. The volunteers under influence of alcohol and the patients under benzodiazepines had a considerable decrease in performance. CONCLUSIONS: Long-term therapy with opioids does not inevitably impair complex skills, but the decision to permit driving a car can only be made in the individual case. PRACTICAL RECOMMENDATIONS: At the beginning of therapy with opioids the physician has to fulfil his duty to inform the patient of any possible dangers of treatment. From the medical point of view, driving must be prohibited until a stable opioid dosage is reached. Any changes in dosage (increase, reduction), change of the opioid and poor general condition independent of the opioid therapy must result in prohibition of car driving. Continuous control of the therapy with documentation is a duty of the physician. The written documentation should include the patients' physical and mental condition, side effects and the therapeutic result. From the medical point of view, driving can be possible when dosage treatment and general condition remain stable. In any case, the doctor has to remind the patient of the responsibility of critical self-examination. In doubt, special performance investigation should be taken into consideration.

English Abstract↗
PubMed1993

[Analysis of the therapy of chronic pain. A comparison of previous therapy and specialized pain therapy].

In Germany patients with chronic pain are often undertreated. It is necessary to establish more specialized institutions for pain therapy. As pain therapy is time consuming and labor intensive the costs must be justified by quality and efficiency. METHODS. We analyzed the new patients who came to our pain clinic in 1990 and compared the previous nonspecialist pain-related treatment with our pain therapy. For each patient we recorded the duration of pain therapy in the past, the number of physicians involved in the treatment, the number and duration of hospital stays and the number of operations carried out to relieve pain. For our pain therapy we recorded the number of treatments on an outpatient basis, the number of patients who were hospitalized and the number of hospital days. The outcome of our pain therapy was determined on a visual analogue scale (VAS). Pain relief of more than 50% was defined as adequate pain therapy. RESULTS. In 1990 we treated 379 new patients in our pain clinic. The largest group (140, 37%) had pain of the muscle or skeletal system. A further 75 patients (18%) had neuropathic pain, 66 (17%) suffered from cancer pain, several types of headache were found in 57 patients (15%), 19 patients (5%) had phantom limb pain, 11 (3%) suffered from reflex sympathetic dystrophy, and we diagnosed psychogenic pain in 11 patients (3%). On average the patients had been treated for their pain over a period of 10 years by eight different physicians. Patients suffering from migraine had the longest duration of preliminary therapy (19.2 years), while patients with cancer pain were pretreated for 2, 3 years in the period before. 80% (n = 302) of all patients were hospitalized at least once. A total of 20,959 hospital treatment days was registered. At least one operation was performed in 34% of the patients (n = 130) to relieve the pain. For all patients the pain relief afforded by the preliminary therapy was insufficient. In our pain therapy the patients had on average 6.5 outpatient appointments. We hospitalized 45 patients (12%), for a mean of 11 days. During the observation period 74% of the patients (n = 280) obtained pain relief of more than 50% in comparison with the start of treatment. CONCLUSION. The findings of our retrospective study demonstrate that specialized pain therapy is evidently effective. If such therapy is instituted early enough, chronic pain can be prevented. Shorter duration of disease, fewer stays in hospitals and less absence from work could reduce the economic costs of chronic pain. It is necessary to make specialised pain therapy a regular component of clinical practice; this means redoubling our efforts concerning education and experimental and clinical studies. The efficiency of pain therapy must be documented in order to improve the care of patients with chronic pain.

Chronic Disease↗
PubMed1992

[Drug dependence in therapy of chronic pain].

The use of drugs in pain therapy is characterized by the fear of addiction. As a result strong analgesics are underused. To compensate the missing analgesic effect the additional use of psychotropic drugs is common. There is still little knowledge that just this therapeutic strategy of underuse leads to iatrogenic addiction. To avoid misunderstandings and irritations in the discussion around addiction, there must be clearly distinguished between physical and psychological dependence. There is sufficient evidence that especially tranquilizers and mixed analgesics induce the development of psychological dependence. In pain therapy there is no indication for these substances. In contrast opioids can be used without causing psychological dependence, presuming the guidelines of drug therapy in chronic pain (e.g. WHO guidelines) are attended.

Adult↗