UI - 000130

AU - Morawetz RF

AU - Schreithofer D

AU - Bostjancic G

AU - Walter MH

AU - Namestnik E

AU - Benzer H

TI - [The multidisciplinary outpatient pain clinic in relation to anesthesia. An important task for the

anesthesiologist]. [Review] [German]

AB - Anesthesiologists have always played a leading role in research into pain and its treatment. Their

efforts, however, have been focused on acute or postoperative pain problems. It was the American

anesthesiologist John J. Bonica who fought for an increased interest in chronic pain. The establishment of

the first Multidisciplinary Pain Center at the University of Washington in Seattle, the foundation of the

International Association for the Study of Pain (IASP) and Melzack and Wall's now 25 year old gate control

theory were the driving forces behind rapid developments in research and treatment in the area of chronic

pain. The realization that chronic pain was the most frequent cause of disability in the United States also

gave an impetus for new efforts in treatment. The classic anesthesiological topics, such as operative

anesthesia emergency medicine and intensive care, have been extended to include acute pain services and

chronic pain treatment facilities. This reflects the understanding that anesthesiological knowledge and

techniques can be valuable to patients in severe acute pain and those in lingering long-term chronic pain

phases. Anesthesiologists are skilled in the use of opioid narcotics and in the administration of strong

analgesics. Many severe pain problems can be solved by correct use of the analgesic regimen. Special ways

of administering narcotic analgesics, such as epidural infusion or patient-controlled analgesia, have already

alleviated the pain problems of many patients. Anesthesiological techniques are also crucial in diagnosis.

Sequential differential blockade and simple nerve blocks can be helpful in the diagnosis and classification of

the pain problems. Anesthesiological contributions to a chronic pain service are not restricted to medical

interventions. Organizational skills are also needed for efficient running of multidisciplinary pain treatment

facilities. Clinical practice in surgical anesthesia means that anesthesiologists are experienced in

interdisciplinary work and familiar with the advantages and dangers of team work. Despite international

acceptance of the multidisciplinary approach to chronic pain, there is still a lack of appropriate facilities in

the German-speaking countries, and we consider it important that anesthesiologists commit themselves to

increasing general awareness of what is needed. [References: 45]

SO - Anaesthesist 1990;39:456-46