[Acute exacerbation of chronic non-malignant pain]

Common recommendations for the treatment of acute exacerbations of non-malignant chronic pain (e.g. migraine, trigeminal neuralgia, cluster headache or chronic pancreatitis) are often not adequate to provide sufficient analgesia. Specific recommendations based on the underlying disease mechanisms are usually more likely to offer efficacious treatment algorithms. In the case of migraine, triptanes represent an option to improve analgesia if NSARs fail, and in cluster headache triptanes and especially inhalation of oxygen have been proven to be the most effective measures. German guidelines recommend intravenous procaine, besides pethidine and buprenorphine, for the management of acute exacerbations of chronic pancreatitis. The objective of this survey is to provide recommendations for the treatment of acutely exacerbated pain states on the basis of international guidelines. The authors place particular emphasis on parenteral drug administration to achieve a rapid onset of action.