Herpes-zoster-Update – was gibt es Neues?

Shingles are triggered by the reactivation of an infection with the varicella zoster virus (VZV) and are characterized by specific vesicular skin lesions. Mostly, elderly patients are affected. Depending on the affected dermatome, some serious complications can be observed. The introduction of a vaccine against shingles in Germany offers a great potential for reducing the frequency and severity of this disease. There are both a live vaccine, which is no longer recommended, and an inactivated vaccine, which, however, is still not sufficiently recommended to the authorized patient groups and is also only available to a limited extent due to delivery bottlenecks. HZ neuralgia is a serious complication of the disease that requires rapid and effective therapy and should be handed over to experienced pain therapists rather too early than too late. Unfortunately, in everyday clinical practice only a few people are familiar with VZV vasculopathy, which is associated with a significantly increased risk of cerebral insults.

Recommendations for a Pediatric Pain Education Curriculum for Physical and Occupational Therapists: Scoping Review and Survey

Specialization training for physiotherapists, occupational therapists, and sports therapists involved in pediatric pain is scarce and curricula are rarely published. The objectives of this study are twofold: firstly, to perform a scoping review to derive important contents for a pediatric pain education curriculum for specialized pain therapists. Secondly, to conduct a survey on specific contents in curricula currently used by pain experts and to obtain their evaluation regarding the importance of such contents for a specialized curriculum. The review substantiated the importance of a specific curriculum in pediatric pain education, but provided little information on adequate contents. In the survey, 45 experts in pediatric pain education confirmed that specific curricula and specialized contents for pediatric pain education are missing. Their answers give a well-defined picture of the specifics needed in the interaction with a pediatric population. The most important items they classified were e.g., the biopsychosocial framework and the impact of pediatric pain on daily life. Those expert ratings were in line with the recommendations of pediatric pain management guidelines. Further curriculum work in an interdisciplinary, international network is highly recommended.

Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain. The present state of the art of SCS in the treatment of chronic neuropathic pain is here overviewed and speculations on whether to use a trial period or direct implant, to choose between percutaneous leads or paddle electrodes and on the pros and cons of the different patterns of stimulation presently available on the market (tonic stim, high-frequency stim and burst stim) are described.

Management Procedures Pain Used by Dental and Maxillofacial Surgeons: An Investigation With Special Regard To Odontalgia

ABSTRACT Background Little is known about the procedures used by indian dental and maxillofacial surgeons treating patients suffering from chronic orofacial pain (COP). This study aimed to evaluate the ambulatory management of COP. Methods Using a standardized questionnaire we collected data of dental and maxillofacial surgeons treating patients with COP. Therapists described variables as patients’ demographics, chronic pain disorders and their aetiologies, own diagnostic and treatment principles during a period of 3 months. Results Although only 14.5% of the 520 addressed therapists returned completely evaluable questionnaires, 985 patients with COP could be identified. An orofacial pain syndrome named atypical odontalgia (16.0 %) was frequent. Although those patients revealed signs of chronification, pain therapists were rarely involved (12.5%). For assessing pain the use of Analogue Scales (7%) orinterventional diagnostics (4.6%) was uncommon. Despite the fact that surgical procedures are cofactors of COP therapists preferred further surgery (41.9%) and neglected the prescription of analgesics (15.7%). However, most therapists self-evaluated the efficacy of their pain management as good (69.7 %). Conclusion Often ambulatory dental and maxillofacial surgeons do not follow guidelines for COP management despite a high prevalence of severe orofacial pain syndromes.

Modern anaesthetic techniques and anticoagulation

SummaryThe many possibilities for anticoagulant pharmacotherapy are constantly increasing. Anaesthetists and pain therapists are confronted with patients being treated with highly effective anticoagulants and/or platelet aggregation inhibitors for coronary heart disease, stroke or peripheral arterial occlusive disease. These patients in particular benefit from neuraxial blockade when undergoing cardiac surgery, revascularisation procedures or amputation. The anaesthetist needs to be familiar with the pharmacology, indications, and adverse effects of the various anti- and procoagulant substances, and to integrate this knowledge into the management concept to prevent haemorrhagic complications.This review presents the basics of coagulation, sites of action of currently-used anticoagulants, and the Austrian standards for performing modern central and peripheral nerve blocks in patients on antithrombotic medication. Preoperative assessment of existing anticoagulant therapy is also very important in general anaesthesia, as this can be used to determine the appropriate procedures for perioperative coagulation management. In order to prevent bleeding complications in patients on antithrombotic therapy, the following questions are addressed and appropriate recommendations given: intervals between administering anticoagulant agents and puncture/removal of catheters or a general anaesthesia and surgery; the choice of local or regional anaesthetic method and of intraoperative coagulation analysis; reversal of anticoagulation in acute situations.