[Efficacy of biofeedback in patients with chronic low back pain : Impact on pain intensity, psychological factors and stress markers]. / Effektivität von Biofeedback bei Patienten mit chronischem Rückenschmerz : Einfluss auf Schmerz, psychologische Faktoren und Stressmarker.

BACKGROUND: The treatment of patients with chronic pain should be carried out in interdisciplinary multimodal pain programs of which relaxation methods represent an integral part. The German disease management guidelines (NDGM) on nonspecific low back pain currently do not recommend biofeedback as a relaxation technique for chronic low back pain due to inadequate data. Furthermore, health insurances do not cover the costs of this treatment. METHODS: The efficacy of a 2-week biofeedback treatment was evaluated in a study of 10 patients with chronic nonspecific low back pain and 10 healthy, age and gender-matched subjects. The parameters "well-being", "depressive mood" and "pain-related disability" were assessed based on three psychometric tests (KAB, ADS and PDI). The pain intensity was measured using a numeric rating scale (NRS) and biofeedback measurement parameters themselves as well as stress markers in blood (noradrenaline, cortisol and MMP-2) were also measured. RESULTS: The relaxation response was demonstrated by the biofeedback-parameters. The treatment led to an improvement in well-being, depressive mood and pain-related disability. These results correlated with a reduction of noradrenaline and MMP-2 blood levels, whereas cortisol concentrations showed no change. CONCLUSION: Biofeedback relaxation is a suitable method in the treatment of chronic non-specific low back pain. Its use in interdisciplinary multimodal pain programs should be encouraged.

[Quality of postoperative pain therapy: evaluation of an established anesthesiology acute pain service]. / Qualität der postoperativen Schmerztherapie : Evaluation eines etablierten anästhesiologischen Akutschmerzdiensts.

BACKGROUND: Despite well-designed concepts of perioperative pain management, recent studies have revealed that a large number of patients still suffer from unacceptable pain after surgery. The purpose of this prospective evaluation was to critically analyze postoperative pain treatment provided by a routinely established, DIN certified acute pain service (APS) at the University Hospital Großhadern in Munich. MATERIALS AND METHODS: A total of 1,000 consecutive patients received one of the following analgesic procedures: continuous epidural analgesia (EA, n = 401), continuous and patient-controlled epidural analgesia (PCEA, n = 305), intravenous patient-controlled analgesia with opioids (PCA, n = 169) or continuous peripheral nerve block (CPNB, n = 125). For EA and PCEA, ropivacaine 0.2 % and sufentanil 0.24 µg/ml were administered while peripheral regional analgesia was performed with infusion of ropivacaine 0.2 % only. Patients with PCEA were allowed a 3 mg bolus once per hour on demand. Standardized intravenous PCA was performed with piritramide 2.5 mg/ml, a bolus of 2.5 mg, a lock-out time of 15 min, a maximum of 25 mg/4 h and no background infusion. During the daily visits the APS assessed pain intensity at rest and during movement on a numerical rating scale from 0 (no pain) to 10 (maximum pain), acceptance of pain, satisfaction with the analgesic procedure, demand of additional non-opioid analgesics, the need for optimization including bolus applications and changes of the infusion rate or retraction of the epidural catheter. The duration of the procedures, side effects and complications were documented. The catheter insertion sites were inspected daily for redness and tenderness on palpation. RESULTS: In general, epidural and peripheral regional analgesic techniques were superior in terms of postoperative analgesia to intravenous opioid PCA and were associated with fewer side effects, such as sedation, nausea, vomiting, obstipation and sensorimotor deficits. A subgroup analysis revealed that in major upper abdominal surgery, EA provided significantly better analgesia at rest and during movement than PCA. In lower abdominal surgery PCEA induced significantly better analgesia than both PCA and EA, especially during movement. Patient satisfaction was generally high and was best with PCEA (95 %) followed by CPNB (94 %), EA (91 %) and PCA (88 %). On the first postoperative day analgesic procedures had to be optimized (e.g. by bolus administration, retraction of catheters or changes to standardized PCA) in 23 % of EA patients, 10 % of PCEA patients, 6 % of PCA patients and 12 % of CPNB patients. Major complications, such as neuraxial hematoma, infections or respiratory depression were not observed. CONCLUSIONS: As described in many prospective studies, this evaluation revealed that for postoperative pain control, regional anesthesia is superior to intravenous patient-controlled analgesia with strong opioids in terms of analgesia and side effects. In the setting of a well-organized acute pain service with frequent education and training of all members involved, postoperative pain management is safe and effective. However, regular re-evaluation of the defined and certified procedures is necessary.