[Chronic pain syndrome in uorology]

[Pain management in urology]

This article reviews aspects of postoperative and chronic pain management in urology patients. Continuous epidural techniques are recommended for extensive retroperitoneal und transperitoneal surgery due to its excellent analgesia and facilitation of enhanced recovery. In patients without regional analgesia techniques, intravenous or oral non-opioid analgesics should be combined with titration of fast acting opioids on an as-needed basis. Oral slow-release opioids are increasingly being used as part of systemic pain management although little evidence exists. Local wound infiltration and transcutaneous electrical nerve stimulation (TENS) treatment are simple and effective supplements for postoperative pain management. In 70-90% of urological cancer patients pain can be adequately relieved by consistent adherence to the WHO cancer pain recommendations. Additional pain relief approaches, such as radiation as well as psychosocial and spiritual needs of these patients have to be considered. In long-term treatment of non-cancer pain, effective use of opioids is not evidence-based. These patients often benefit from multimodal, interdisciplinary pain management comprising psychological and educational approaches as well as activating physiotherapy.

[Preoperative pain in urological patients scheduled for surgical intervention : Incidence, severity and chronicity]

BACKGROUND

The genesis of chronic pain in urology has so far been insufficiently investigated. No investigations have focused on the occurrence of preoperative pain. We developed an epidemiological questionnaire to analyze preoperative pain.

METHODS

In this questionnaire, preoperative pain in all patients scheduled for urologic surgery (n=165) was analyzed. Acute and chronic pain was analyzed as main or adjoint pain, with the registration of severity, chronification states, and duration. We registered depression and anxiety, well-being, and somatic and psychological efficiency.

RESULTS

Eighty percent of the patients reported pain within the previous 12 months. Acute preoperative pain was reported by 17% of the patients and chronic pain by 64%. Significant differences in quality of life were detected between patients with or without preoperative pain. Well-being was also significantly affected in patients having pain.

CONCLUSION

The pain severity and states of chronification not only explain a reduction in somatic and psychological well-being but also emphasize that preoperative pain should be identified thoroughly prior to surgery.

[Special pain conditions in urology. Summary, literature review and suggestions]

The diagnosis of acute or chronic pain syndromes of the urogenital system can be verified and successfully treated by exact exploration of the patients medical history, the physical examination and a few image-guided or laboratory analyses Pain conditions which remain of unknown etiology even after extensive investigations are difficult to treat by the urologist alone. In cases where no causally determined morphological changes can be found or the alteration is disproportionate to the discomfort sensed by the patient, a multidisciplinary therapy strategy offers an approach to find a solution.

Psychopharmacological treatment of dermatological patients – when simply talking does not help

In dermatology, primary emotional disorders with cutaneous manifestations, secondary emotional disorders caused by dermatoses and multifactorial diseases are possible indications for the use of psychopharmaceuticals. Neuroleptics (anti-psychotics) are usually used in psychiatric illnesses, while antidepressants are foremost in treating depression as well as obsessive-compulsive, anxiety and panic disorders. Minor tranquilizers may be used symptomatically. To define the indications for mid- and long-term treatment with psychopharmaceuticals, the unequivocal diagnosis of the main and secondary psychiatric symptoms as well as the primary target symptoms must be designated. At the start of therapy planning, any possible desired and undesired side effects must be taken into account, such as stimulation, sedation, anticholinergic side effects or weight gain. The main antidepressants are the well-tolerated selective serotonin reuptake inhibitors (SSRI) such as sertraline, fluoxetine or citalopram. A clear long-term plan and how to monitor it must be discussed with patient carefully because of the need for individual dose titration and the late onset of action of many of these medications. Good results can be achieved in dermatologic patients requiring psychopharmaceuticals if the indications are carefully assessed and the therapy logically structured.

[Nihilodermia in psychodermatology]

"Nihilodermia" refers to a group of difficult "problem" patients in dermatology without objective findings but with recurrent symptoms and stubborn demand for medical examination. These primary emotional disorders are somatoform disorders, but the patients usually strictly deny a psychosocial aspect and expect purely somatic treatment. Clinical patterns include pruritus, pain, paresthesias, feelings of disfiguration, eco-syndromes, erythrophobia and psychogenic pseudoeffluvium. The relevant somatoform disorders in dermatology can be differentiated as somatization disorders, hypochondriacal disorders, somatoform autonomous disorders, persistent somatoform pain disorders and "other somatoform disorders". A precise differential diagnostic division is necessary in order to initiate adequate therapy strategies.