This study presents a German version of the McGill Pain Questionnaire (MPQ) developed by strict adherence to the methodology originally employed by Melzack and Torgerson. Three groups of subjects participated: The first group (n = 40) was used to construct a 5-point intensity scale. The second group (n = 42) was presented a preliminary translation of the MPQ and asked to assign an intensity rating out of the 5-point intensity scale to each of the 78 adjectives. In the last phase, adjectives whose mean ratings differed markedly from those in the original MPQ were resubmitted, along with 3-4 synonyms to a third group (n = 40) who was again asked to assign an intensity value to each word. Finally, the adjectives whose ratings corresponded closest, and thus resulted in congruent rank positions to those of the English originals, were selected. The present counterpart to the MPQ retains the original grouping of adjectives, the identical number of words per group as well as their rank positions within groups. Thus a comparison between German and English mean ratings, rank values and number of words chosen as well as statistical calculations derived therefrom is feasible.

Patient controlled analgesia increases pain tolerance, decreases narcotic requirements, simplifies ESWL as an outpatient procedure and can be used to quantify analgesic requirements during lithotripsy. Pain and tolerance thresholds of electrocutaneous sensitivity are sensitive markers of pain tolerance during lithotripsy, which may be more pronounced in male patients.

Sixty patients undergoing shock wave lithotripsy of gallbladder stones (ESWL) were randomly assigned to receive alfentanil either by infusion controlled by the attending anesthesiologist (standard treatment group, n = 31) or by analgesia controlled by the patient (PCA group, n = 29). Patients using PCA were allowed to self-administer 0.25 mg of alfentanil i.v. every minute as required. Data collected during treatment included the total dose of drug required, transcutaneous pCO2 values, verbal pain and sedation scores, visual analogue scale (VAS) patient satisfaction scores, and the incidence of nausea or vomiting. PCA patients used less alfentanil than the standard treatment group (PCA group: 12.8 micrograms/kg; standard treatment group: 44.3 micrograms/kg; mean values, P = 0.0001), tolerated significantly higher pain intensities and self-administered the narcotic only to moderate levels of pain but not to pronounced analgesia. Standard treatment patients reported lower levels of pain, were more sedated (P less than 0.05) and showed significantly higher transcutaneous pCO2 values. There was a trend towards a lower incidence of nausea or vomiting in PCA patients without reaching statistical significance. No significant difference with regard to patient satisfaction with pain relief could be demonstrated. Self-administered alfentanil during ESWL of gallbladder stones provided adequate analgesia with minimal side effects and high patient satisfaction. ESWL may represent a new and useful indication for PCA.

Patient controlled analgesia increases pain tolerance, decreases narcotic requirements, simplifies ESWL as an outpatient procedure and can be used to quantify analgesic requirements during lithotripsy. Pain and tolerance thresholds of electrocutaneous sensitivity are sensitive markers of pain tolerance during lithotripsy, which may be more pronounced in male patients.

No abstract