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Biomedical subjects

M Strumpf

Publications and source records attributed to M Strumpf.

36 records · Page 2Linked to original sources
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↗
PubMed1996

[The sympathetic skin response--a useful method for the diagnosis of reflex sympathetic dystrophy?].

UNLABELLED: The aim of the present study was to examine the value of the sympathetic skin response (SSR) in the diagnosis of reflex sympathetic dystrophy (RSD). PATIENTS AND METHODS: SSR was recorded in 20 normal subjects and in 24 patients with predominantly chronic RSD. In 3 patients with RSD, additional recordings of the SSR were performed before and several times after administration of local anaesthetics via a plexus catheter on the diseased side. SSR was recorded with standard EMG apparatus. Disc electrodes were positioned on the middle of the volar and dorsal surfaces of the hands and feet. Electrical stimuli were applied to the middle of the forehead at irregular intervals longer than 60 s. RESULTS: In normal subjects inter- and intraindividually different monophasic, biphasic and triphasic potentials without difference in the waveform between sides were recorded. SSR abnormalities were found in 15 patients with RSD and correlated with the severity of the disease. In patients with slight dystrophy SSR was predominantly normal, while in most of those with intermediate dystrophy differences in the SSR waveform between sides were observed. In the presence of severe dystrophy SSR amplitude was predominantly decreased on the affected side. Following the administration of local anaesthetics via a plexus catheter, the differences in SSR waveform became smaller in patients with initial distinct side difference of the waveform. However, differences in SSR amplitudes or latencies between sides were not affected. CONCLUSIONS: Side differences in SSR waveform could be due to a mild, reversible unilateral sudomotor dysfunction, whereas differences in SSR amplitude or latency indicate more serious damage to sudomotor activity, possibly due to dysfunction of autonomic fibres. In patients with slight dystrophy sweat secretion is predominantly normal, while in severe dystrophy more serious damage to the sweat secretory system can be observed. SSR provides useful information on sudomotor dysfunction in patients with RSD. However, as there is no consensus on the clinical criteria for diagnosis of RSD, it is also not possible to determine the diagnostic value of SSR in the diagnosis of RSD.

English Abstract↗
PubMed1996

[Oral opioids for long-term treatment of chronic non-cancer pain].

The treatment of cancer pain with opioids is well accepted. However, the use of opioids for the treatment of non-cancer pain is still a matter of controversy. The main matters of concern are physical dependence and opioid abuse. Another argument against opioids is the lack of efficacy. Experiences with opioids in non-cancer pain have been published on about 850 patients, the longest therapy lasting almost 14 years. 85% of the patients treated with opioids had beneficial effects. In a number of investigations evaluating the opioid sensibility of pain by PCA and intravenous infusions, 67-80% of the patients with neuropathic pain responded to opioids. The efficacy of opioids in the treatment of non-cancer pain was proven in 3 placebo controlled studies. In 2 studies pain reduction in neuropathic pain was similar to that in nociceptive pain. When opioids are used, the administration has to be performed according to well defined standards. The indication for opioids must be made by a specialist in pain management. The diagnosis must clearly reveal an organic origin of the pain. Before the start of therapy the duration as well as the criteria for discontinuation must be set up. The treatment must be controlled by a specialist team and frequent regular follow up investigations must be performed. These must include proper documentation of the pain level, changes in patients' function and in social activities. The reliable intake of prescribed medication must be assured if necessary by laboratory screening. The treatment of non-cancer pain with opioids may be an alternative for those patients, who didn't gain sufficient reduction of pain by other therapies. Standards for this therapy are an absolute necessity and are to be followed closely.

Analgesics, Opioid↗
PubMed1995

Sympathetic skin response in patients with reflex sympathetic dystrophy.

The sympathetic skin response (SSR) originates from synchronized activation of the sweat glands as a response to a volley discharge in efferent sympathetic nerve fibres. The aim of the study was to verify the diagnostic value of SSR in patients with reflex sympathetic dystrophy (RSD). SSR was recorded in 20 normal subjects and in 24 patients with predominantly chronic RSD. In normal subjects inter- and intra-individually different mono-, bi- and triphasic potentials could be recorded without difference of the waveform from side to side. SSR abnormalities were found in 15 patients and correlated with the severity of the disease. In patients with slight dystrophies, SSR was predominantly normal. In intermediate dystrophies, mainly differences of the SSR waveform between sides could be recorded, indicating unilateral sudomotor dysfunction. In severe dystrophies abnormalities of SSR amplitude or latency were found, indicating more serious disturbance of sudomotor activity, possibly due to a lesion of sympathetic fibres. The SSR provides useful information on sudomotor dysfunction in patients with RSD. However, as there is no consensus in the literature for the clinical criteria to diagnose RSD, it is not yet possible to determine the final diagnostic value of SSR for the diagnoses of RSD.

Adult↗
PubMed1995

Severe undertreatment of cancer pain: a 3-year survey of the German situation.

The aim of this survey was to determine the prescribing patterns of German physicians in the treatment of cancer pain. The computerized patient records of 330 practices, which treated a total number of 1,104,435 patients over a 3-year period, were analyzed. "Strong" opioids, widely accepted in the management of severe cancer pain, were prescribed to just 322 of 16,630 cancer patients (1.9%). Only 99 (0.6%) patients received more than three prescriptions during more than 3 weeks of treatment. Additionally, many prescriptions mandated inadequate time intervals for the dosing, and 12% of the prescriptions were given "as required." From these data, it can be concluded that the majority of cancer patients in Germany are not treated for pain at all, and that those patients who receive treatment are treated inadequately. Germany is still a developing country in terms of pain therapy. This situation is symptomatic of many countries and reflects the continuing prejudice against opioids.

Analgesics, Opioid↗
PubMed1993

[Does the mixture of bupivacaine and prilocaine as opposed to bupivacaine afford a clinical advantage in epidural anesthesia?].

Local anaesthetic mixtures are often used to shorten the onset of regional anaesthesia. However, the results of these mixtures of epidural anaesthesia (EDA) are controversial. Alkalinisation of bupivacaine shortens the onset of EDA. Since mixing prilocaine with bupivacaine results in a local anaesthetic mixture with a pH of 6.8, we investigated whether this mixture can shorten the onset of EDA compared to plain bupivacaine. METHOD. In a randomised, double-blind study, 60 patients received single-shot EDA with a standardised amount of local anaesthetic (1 ml/segment for 150 cm body height +0.1 ml/segment for each further 5 cm). Group A received plain bupivacaine 0.5%, group B bupivacaine 0.5% and prilocaine 2% in a 1:1 ratio. Sensory (loss of warm/cold and pinprick sensation) and motor blockade (modified Bromage score) were studied 5, 10, 15, 20, 30, and 40 min after injection of the local anaesthetic. RESULTS. There was no difference in the onset of sensory blockade: loss of warm/cold and pinprick sensation developed in the same manner in both groups. Ten minutes after injection all patients showed changes in the perception of warm and cold stimuli. In group A this ranged from T 8.1 +/- 2.14 to L 4.36 +/- 1.79 and in group B from T 8.8 +/- 2.0 to L 4.4 +/- 1.55. Forty minutes after injection loss of warm/cold sensation ranged from T 6.6 +/- 2.89 to L 5.4 +/- 1.42 in group B and from T 7.2 +/- 1.24 to L 5.7 +/- 0.88 in group A. Nearly the same results were obtained for the pinprick test. Motor blockade developed more rapidly and intensely in group B. At the end of the observation period there were still 5 patients without any motor blockade in group A, while all patients in group B showed signs of motor blockade. DISCUSSION. Shortening of the onset times has been observed when alkalinized local anaesthetic solutions with a pH above 7.0 are used for EDA. In the present study the mixture of prilocaine and bupivacaine did not shorten the onset of EDA, most likely because the pH of this mixture is only 6.8. In contrast to peripheral nerve blocks, mixtures of local anaesthetics for EDA do not offer a clinical advantage with respect to onset time compared to plain local anaesthetics.

Adolescent↗
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↗
PubMed1993

[The anterior sonographic-guided celiac plexus blockade. Review and personal observations].

The coeliac plexus block is an approved method for the relief of upper abdominal pain due to cancer of the upper intra-abdominal viscera or to chronic pancreatitis. While there are many reports concerning the posterior approach to the coeliac plexus block, little attention has been given the anterior approach. There are two ways of implementing the anterior approach to the coeliac plexus: CT-guided and the ultrasound guided approach. METHODS. The ultrasonic-guided anterior approach to the coeliac plexus block is used with the patient in the supine position. The aorta and discharge of the truncus coeliacus or the a. lienalis respectively, are ultrasonographically presented at two levels. After setting local cutaneous and subcutaneous anaesthesia, a 15-cm-long 25 G-needle is introduced into the epigastrium. The point of the needle is--ultrasonographically guided--inserted into the pre-aortic area near the discharge of the truncus coeliacus. The position of the needle point is ultrasonographically controlled on two levels. For the enforcement of a diagnostic coeliac plexus block after careful aspiration on two levels, 10 ml of bupivacaine 0.5% is injected. The spread of the solution is evaluated by ultrasound. If the needle position is correct; a few minutes later the patient has a feeling of warmth in the upper abdominal region. For the enforcement of a neurolytic coeliac plexus block 10 ml ethanol 96% and 10 ml prilocaine 1% can be administered. The two solutions are applied as small volumes in permanent succession. Thus the burning pain, which is often observed after the injection of alcohol, is avoided. RESULTS. In the literature there are only a few reports, about the results and side-effects after use of the anterior approach in the coeliac plexus block. The results of these investigations and our own show total pain relief or at least good pain reduction by at best 85%. The reduction in pain achieved continues in as many as 60% of the treated patients. There is the possibility to stop or at least reduce the analgesic premedication. These results are comparable with those after using the posterior approach to the coeliac plexus block. When carrying out the anterior approach in the coeliac plexus block, most of the patients showed increased intestinal motility. Therefore, about 60% of all patients had transitory diarrhoea. In 12-25% of the patients orthostatic hypotension was observed. This side-effect is avoided by an appropriate infusion before enforcement of the block. In a frequency of 4-100% the occurrence of burning pain was reported during injection of the alcohol. No serious side-effects were observed. CONCLUSIONS. The results concerning total pain relief or at least pain reduction are comparable to the posterior approach for the block. Nevertheless, there are some advantages to the ultrasound-guided anterior approach. There is less risk using this technique. No methodological complications have been observed so far. There is no risk of neurological complications such as paraplegia. Because the patients remain in the supine position, the anterior approach to the coeliac plexus block is suitable for terminally ill patients, who are not able to tolerate the prone position and need careful supervision and good ventilation. Also, no contrast medium is necessary. Only a small volume of local anaesthetics or alcohol is required. We prefer the anterior approach of the coeliac plexus block as a fast, safe and cost-effective method, which should receive increasing attention during the next few years.

Abdominal Pain↗
PubMed1992

Long-term oral opioid therapy in patients with chronic nonmalignant pain.

In contrast to the use of opioids for the treatment of acute and chronic cancer pain, the administration of chronic opioid therapy for pain not due to malignancy remains controversial. We describe 100 patients who were chronically given opioids for treatment of nonmalignant pain. Most patients experienced neuropathic pain or back pain. We used sustained-release dihydrocodeine, buprenorphine, and sustained-release morphine. Pain reduction was measured with visual analogue scales (VAS), and the Karnofsky Performance Status Scale was used to assess the patient's function. Good pain relief was obtained in 51 patients and partial pain relief was reported by 28 patients. Only 21 patients had no beneficial effect from opioid therapy. There was a close correlation between the sum and the peak VAS values (r = 0.983; p less than 0.0001) and pain reduction was associated with an increase in performance (p less than 0.0001). The most common side effects were constipation and nausea. There were no cases of respiratory depression or addiction to opioids. Our results indicate that opioids can be effective in chronic nonmalignant pain, with side effects that are comparable to those that complicate the treatment of cancer pain.

Adult↗
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↗
PubMed1989

[Retard morphine in the long-term therapy of severe tumor pain].

35 patients with severe cancer pain received oral retard morphine. Pain reduction was achieved in each case; duration of effectiveness was between 8 and 12 hours. Mean daily dose was 230 mg morphine, but in individual cases the maximal daily dose had to be over 800 mg. The Karnofsky index of physical capacity was increased in all patients. The main side effect was constipation, which actually increased in the course of treatment. On the other hand, nausea and vomiting decreased after a few weeks. No dependence developed in any of the patients. This form of morphine medication thus was effective over long periods and it has become an important part in the range of strongly effective analgesics.

Adult↗
PubMed1978

Effects of glucocorticoids on osteoclast-activating factor.

Glucocorticoids lower the serum calcium in patients with hypercalcemia due to myeloma and related lymphoproliferative disorders. OAF is a potent bone-resorbing lymphokine which is probably responsible for the bone lesions and hypercalcemia which occur in patients with these hematological neoplasms. In this study, we have examined the effects of cortisol on the production of OAF and its biological activity in order to clarify the mechanism of action of glucocorticoids in lowering the serum calcium in these disorders. The effects of OAF-containing media on bone resorption were inhibited by cortisol at concentrations from 10-5M to 10-9M. In contrast, OAF production was not inhibited by cortisol at concentrations less than 10-5M. These data support the hypothesis that glucocorticoids inhibit the effects of OAF in vivo primarily by a direct effect on bone resorption.

Animals↗