[Quality characteristics concerning pain therapy]. / Qualität in der Therapie chronischer Schmerzen - Methoden zur Messung des Therapieerfolges.

The Institute of Medicine (IOM) reports "Crossing the Quality Chasm proposed 7 aims for high-quality healthcare: effective, safe, timely, efficient, equitable, patient-centred, and emphasized care coordination. The quality of pain treatment can also be shown by structure quality, process quality, and outcome quality. The present investigation shows methods of the qualitative capture of pain therapy. On this occasion, it is shown whether such a pain measurement with the available parameters is generally possible and which parameters are necessary for this. However, quality parameter and quality outcome must be regarded individually for every patient. Quality measurement concerning the therapy of chronic pain diseases is an interaction of several quality and outcome parameters. Furthermore patients' aims concerning his individual pain treatment must be taken into account.

[Analgetics, co-analgetics and opioid-analgetics in the elderly]. / Perioperative Analgesie: Opioide, Nicht-Opioid-Analgetika und Co-Analgetika.

There is a continuous increase in the proportion of elderly patients. Therefore physicians should be aware of specifics according to pain therapy in the elderly. This review will concentrate on selected topics related to pain therapy in the elderly patient. Furthermore specific consequences according to drug therapy are shown.

[Opioids: modern concepts of pain management]. / Opioide -- moderne Konzepte der Schmerztherapie.

In cancer pain management the application of opioids is established and follows the WHO guidelines. In the management of chronic non-cancer pain opioids are used increasingly but the effectiveness is less. Several central and gastrointestinal side effects can limit the outcome. A careful patient selection is necessary and indications and contraindications must be regarded. The psychomotor performance is not impaired in all patients but must be controlled in the individual patient. In chronic pain management opioids are a component of an interdisciplinary concept and can be used safely by considering therapy rules and supervision.

Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain.

Direct conversion from oral morphine to transdermal fentanyl with a ratio of oral morphine/transdermal fentanyl (100:1 mg) daily was examined in patients with cancer pain. Patients with a 'stable and low level of cancer pain' receiving a constant dosage of sustained release morphine during a pre-study phase of 6 days were included in the study. Initial fentanyl dosage was calculated by a conversion table. The transdermal system was changed every 72 h and the dosage was adjusted to the needs of the patients according to the VAS scores and the requirement of liquid morphine, which was allowed to achieve sufficient pain relief. Regression analysis at the end of the study revealed a mean morphine/transdermal fentanyl ratio of 70:1. Pain relief during treatment with transdermal fentanyl was identical to sustained release morphine. However, significantly more patients took supplemental medication with liquid morphine during transdermal fentanyl therapy. The number of patients suffering from pain attacks did not increase with transdermal fentanyl. Constipation and medication with laxatives decreased significantly during fentanyl therapy. Other side effects and vital signs were identical. Three patients suffered from a morphine withdrawal syndrome beginning within the first 24 h of transdermal fentanyl therapy. Cutaneous reactions to the patch were rare, mild and transient. Patients and physicians reported satisfaction with the transdermal therapy. 94.7% of the patients chose to continue the transdermal fentanyl therapy at the end of the study due to better performance in comparison to oral morphine. Due to these results an initial conversion from oral morphine to transdermal fentanyl with the ratio of 100:1 is safe and effective.