Schmerz最新文献

{"title":"[Factors influencing analgesic use patterns in patients with chronic tumor-associated pain. : A qualitative pilot study considering different groups of medications].","authors":"Marco Richard Zugaj, Andrea Züger, Jens Keßler","doi":"10.1007/s00482-023-00765-y","DOIUrl":"10.1007/s00482-023-00765-y","url":null,"abstract":"<p><strong>Background: </strong>Patients are surviving tumor diseases longer and longer due to the improvement of tumor-specific therapy and pain is a common symptom. The gold standard for tumor-associated chronic pain is multimodal therapy. Non-adherence causes high costs and may put patients at risk. The aim of this study was to investigate the adherence behavior and subjective treatment compliance of patients with tumor-associated chronic pain. The focus was on the patients' perspective. Different groups of medications, such as NOPA, opioids, co-analgesics and cannabinoids, as well as non-drug treatments were included.</p><p><strong>Methods: </strong>Semistructured guided interviews with 10 patients with chronic tumor pain were conducted within a qualitative research approach. The interviews were recorded and transcribed. The evaluation was using a focused content structuring interview analysis according to Kuckartz and Rädiker.</p><p><strong>Results: </strong>Five main categories were defined. The central category based on the research question was \"Adherence behavior from the patient's perspective.\" The category \"Medication therapy\" formed the framework of the study. Other main categories were \"History of illness\", \"Relationship with treatment providers\" and \"Attitudes and beliefs\". A total of 77 additional subcategories were formed and interpreted. Adherence behavior from the patients' perspective differed between the different medication groups. A palliative setting influenced treatment decisions and adherence. The medication regimens used were complex and dynamic, especially when there were multiple practitioners involved. Furthermore, there was ambiguity in the use of cannabinoids. Non-drug therapies were marginalized by patients. From the point of view of the patients interviewed, it was not so much the treatment providers who influenced their adherence behavior, but rather their own experiences, attitudes, and convictions.</p><p><strong>Discussion: </strong>The study included all medication groups and non-drug therapies equally, complementing previous literature in a qualitative setting. Adherence factors known from previous research were reflected in the subjective perception of the group of patients with chronic pain after tumor diseases. Marginalization of non-medication methods could be explained by the fact that multimodal therapy approaches were too rarely constantly used and controlled in the phase of chronification. Therefore, drug and non-drug therapies should be applied even more consistently to patients with tumor-associated pain.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"422-432"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89719444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Current knowledge among German physiotherapists on the subject of pain].","authors":"T Reißner, A Bassimtabar","doi":"10.1007/s00482-024-00846-6","DOIUrl":"https://doi.org/10.1007/s00482-024-00846-6","url":null,"abstract":"<p><strong>Background: </strong>Pain is an omnipresent symptom in the field of musculoskeletal healthcare. Person-centred care in accordance with current scientific recommendations requires comprehensive and evidence-based knowledge about pain. However, there appears to be a lack of knowledge in this area both internationally and nationally.</p><p><strong>Aim: </strong>This study aimed to evaluate the pain-related knowledge and postural-structural-biomechanical (PSB) beliefs regarding pain among physiotherapists practicing in Germany.</p><p><strong>Method: </strong>An online survey, which included the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the Essential Knowledge of Pain Questionnaire (EKPQ), was answered by n = 105 physiotherapists using SoSci Survey. A satisfactory result is achieved when at least 90% of the participants answer at least eight of the 12 questions correctly. Additionally, the possible influence of the variables 'academic degree' and 'working experience' of the participants on the questionnaire scores was investigated.</p><p><strong>Results: </strong>The average score of the rNPQ‑D was 70.8 ± 15.4% (95% CI: 67.8-73.8%). The average score of the EKPQ was 51.4 ± 26% (95% CI: 46.4-56.4%). Neither the rNPQ‑D (69.5% of participants; n = 73) nor the EKPQ (30.6% of participants; n = 32) yielded a satisfactory result. The scores of the questionnaires correlated moderately positively and statistically significantly with each other (r = 0.47; p < 0.001). The average score of the EKPQ was significantly lower than the average score of the rNPQ‑D (p < 0.01; d = 0.84). Academically trained therapists achieved higher average scores than those non-academically trained (p < 0.05; rNPQ-D: d = 0.48, EKPQ: d = 0.42). Furthermore, participants with ≤5 years of professional experience achieved significantly higher scores than participants with >5 years of professional experience (p < 0.05; rNPQ-D: d = 0.75; EKPQ: d = 0.68).</p><p><strong>Conclusion: </strong>The knowledge among physiotherapists in Germany about pain appears to be deficient and strongly PSB-orientated. In addition, academically trained therapists seem to have a more pronounced theoretical and case-related knowledge of pain compared to graduates of vocational physiotherapy training programmes. To ensure successful and effective future treatment of individuals experiencing pain, it is imperative to systematically investigate the potential causes of such deficits. Physiotherapeutic pain care in Germany should strive for a systemic change in favour of evidence-based practice.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Validity of the Chronic Pain Grade Scale in nonspecific chronic low back pain].","authors":"Petra Hampel, Anna Maria Hüwel","doi":"10.1007/s00482-024-00844-8","DOIUrl":"https://doi.org/10.1007/s00482-024-00844-8","url":null,"abstract":"<p><strong>Background: </strong>Higher pain grades are associated with high psychological burden and increase the risk for the persistence of chronic low back pain (CLBP).</p><p><strong>Objectives: </strong>Previous results on the criterion validity of the Chronic Pain Grade Scale (CPGS) have been extended to the context of inpatient multidisciplinary orthopedic rehabilitation (MOR) and have been supplemented with additional psychosocial and work-related measures.</p><p><strong>Methods: </strong>In this multicenter study, psychological, work- and pain-related outcomes were examined among 1010 individuals with nonspecific CLBP (ICD-10: M51/53/54) prior to the beginning of an inpatient MOR stratified by pain grade (I-IV). Additionally, frequency distributions of scores regarding pain-specific self-efficacy, depression, and subjective prognosis of gainful employment by pain grade in patients were investigated.</p><p><strong>Results: </strong>The CPGS differed between all pain grades in the psychological, work- and pain-related outcomes in the expected direction. In post hoc pairwise comparisons, grade IV was significantly different from the lower grades. Patients with higher pain grades showed unfavorable levels in psychosocial parameters and more frequently scores in the clinical range than expected.</p><p><strong>Conclusions: </strong>These results confirm the criterion validity of the CPGS. The psychosocial risk pattern observed in higher pain grades supports the importance of conducting early pain-related and psychological diagnostic assessments and implementing systematic allocation to needs-based interdisciplinary multimodal treatments.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Health services research in acute pain medicine : Where do we come from in Germany?]","authors":"Nadja Nestler, Christoph Maier, Jürgen Osterbrink","doi":"10.1007/s00482-024-00845-7","DOIUrl":"https://doi.org/10.1007/s00482-024-00845-7","url":null,"abstract":"<p><strong>Background: </strong>Up to the early 2000s the need for optimization in the treatment of acute pain in hospitals was highlighted. Only a few successes were achieved in the optimization process. As the acute pain care in Germany remained persistently unsatisfactory, the first health services research projects in pain medicine were initiated. These were intended to achieve improvements in patient care.</p><p><strong>Aim: </strong>To illustrate the beginnings of health services research in the field of pain medicine in Germany the research projects \"Pain-free hospital\" and \"Action alliance pain-free City of Münster\" as well as the certification initiative Certkom are described.</p><p><strong>Material and methods: </strong>An analysis of the current state of pain care for patients and interdisciplinary pain management, the derivation of optimization measures, their implementation and subsequent evaluation were carried out in all the projects presented in the sense of a complex intervention.</p><p><strong>Results: </strong>All the projects could achieve improvements in patient care through a systematic survey of the current situation, targeted planning and the introduction of optimization measures. Corresponding evaluations could demonstrate these results.</p><p><strong>Conclusion: </strong>The systematic approach in the projects with the collation of scientific data in real-life care has achieved optimization in acute pain management. The foundations were laid for further healthcare research in pain treatment in Germany; however, the projects also revealed limitations in the inclusion of vulnerable patient groups.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[What is health services research?]","authors":"Neeltje van den Berg, Wolfgang Hoffmann","doi":"10.1007/s00482-024-00843-9","DOIUrl":"https://doi.org/10.1007/s00482-024-00843-9","url":null,"abstract":"<p><p>In health services research, the health care of the population is examined under everyday conditions. Scientific questions include medical, patient-oriented, system-, performance- and quality-related as well as health economics topics. In health services research, complex interventions, e.g., treatment concepts with multiple therapy components, and/or across multiple sectors, are often implemented. The design of studies in health services research is based on the research question, the setting, and the available data, which can come from a variety of sources.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interdisciplinary multimodal pain therapy: does the dose make a difference? : A comparison from routine clinical care].","authors":"Philipp Baumbach, Peter Storch, Thomas Weiss, Winfried Meissner, Fabian Rottstädt","doi":"10.1007/s00482-024-00838-6","DOIUrl":"https://doi.org/10.1007/s00482-024-00838-6","url":null,"abstract":"<p><strong>Background: </strong>Interdisciplinary multimodal pain therapy (IMPT) is an established treatment for patients with severe chronic pain. Little evidence is available on the role of treatment dosage and, in particular, on the association between the duration of IMPT and treatment outcome.</p><p><strong>Aim: </strong>The aim of this retrospective study was to compare the medium-term treatment success of a short inpatient (SIT, 1 week) and a long outpatient (LOT, 4 weeks) IMPT with a comparable treatment concept and comparable therapy intensity (20 h/week) in patients with severe chronic pain.</p><p><strong>Methods: </strong>Patients in both groups completed the German Pain Questionnaire at the beginning and end of IMPT as well as after 3 months. Primary outcome measures included pain-related impairment and average pain intensity at follow-up in patients of comparable sex, age as well as pain intensity and impairment at the beginning of the therapy.</p><p><strong>Results: </strong>While both groups initially showed significant treatment effects in pain-related impairment and average pain intensity, LOT patients (n = 32) reported significantly better values in both variables at 3‑month follow-up compared with SIT patients (n = 32). This was due to sustained positive effects in LOT patients and worsening in the SIT group.</p><p><strong>Conclusion: </strong>The results indicate that initial treatment effects can be observed in both treatment settings, but a longer duration of therapy seems to favour the long-term stability of treatment effects.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[What determines the overall quality of postoperative pain management? A question of perspective].","authors":"Paula Thomas, Thomas Weiss, Winfried Meissner, Philipp Baumbach","doi":"10.1007/s00482-024-00839-5","DOIUrl":"https://doi.org/10.1007/s00482-024-00839-5","url":null,"abstract":"<p><strong>Background: </strong>The outcome domains pain intensity, pain-related interference, side effects, (treatment) information, participation and personal interaction have all been identified as relevant factors in the management of perioperative pain. However, it is not yet clear which of these are particularly significant for the subjectively perceived overall quality of postoperative pain management.</p><p><strong>Aim: </strong>A newly developed questionnaire was used in this cross-sectional study to assess the relevance of these domains for patients and compare the relevance to healthcare professionals (HCP).</p><p><strong>Methods: </strong>The patient survey (n = 40) was conducted on the first postoperative day at Jena University Hospital, Germany. In order to investigate group differences, 63 HCP (disciplines: n = 15 anaesthesiology, n = 17 surgery, n = 31 nursing) were recruited. The questionnaire primarily included all pairwise comparisons between the domains with regard to the overall quality of postoperative pain management. The resulting sum scores for each domain were the primary outcome measure, which were analysed using generalized estimating equations.</p><p><strong>Results: </strong>Within the group of patients, there were significant differences in the prioritization of the six outcome domains, with personal interaction followed by intensity and interference having received the highest ratings. There were also significant differences within the domains between the perspectives of patients and HCP, as well as between the HCP themselves.</p><p><strong>Conclusions: </strong>The study demonstrates that personal interaction and the reduction of pain intensity and interference are three key factors that are significant for patients' experience of postoperative pain management. However, the extent to which the harmonisation of these three factors with those given prominence by HCP would positively impact postoperative pain management remains unclear and should be investigated further.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Is health care research in an ivory tower?]","authors":"Ursula Marschall","doi":"10.1007/s00482-024-00841-x","DOIUrl":"https://doi.org/10.1007/s00482-024-00841-x","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Our experience, our strength: patient involvement in health services research : Perspective of patient representatives on the Innovation Committee of the Federal Joint Committee].","authors":"Susanne Bethge, Martin Danner, Sophie Schertell","doi":"10.1007/s00482-024-00842-w","DOIUrl":"https://doi.org/10.1007/s00482-024-00842-w","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pain management in German specialized outpatient palliative care : A cross-sectional study to present the current pain management of palliative patients in the home environment].","authors":"Christian Volberg, Julien Corzilius, Julian Maul, Astrid Morin, Martin Gschnell","doi":"10.1007/s00482-023-00693-x","DOIUrl":"10.1007/s00482-023-00693-x","url":null,"abstract":"<p><strong>Background: </strong>With the help of specialized outpatient palliative care teams (German abbreviation: SAPV), seriously ill and dying patients in Germany can be adequately cared for in their home environment until the end of their lives; however, there are no uniform standards or guidelines for well-executed pain management right now.</p><p><strong>Objective: </strong>This approach serves as basic research in the field of public health research. This is intended to present which methods (use of different professional groups, use of pain medications, alternative medical treatment etc.) the individual SAPV teams use for pain management. From this it can be deduced which procedures can be considered particularly effective.</p><p><strong>Material and methods: </strong>This cross-sectional study was conducted in May 2021. All German SAPV teams (n = 307) listed on the homepage of the German Association for Palliative Medicine (DGP) were contacted by post and invited to participate. A total of 175 teams (57%) responded to the request and were included in the evaluation. A descriptive data analysis was performed.</p><p><strong>Results: </strong>Pain management in the German outpatient care of palliative patients is based on several components. All common pain medications are used, but primarily metamizole (99.4%) as a non-opioid analgesic, morphine (98.3%) from the opiate series and pregabalin (96.6%) as a co-analgesic are mainly prescribed. If pain therapy fails, 22.5% of the SAPV teams perform palliative sedation for symptom control on a regular basis.</p><p><strong>Conclusion: </strong>This cross-sectional study is the first of its kind to provide a general overview of the treatment options for pain management in German outpatient palliative care. In comparison with international studies, the question arises as to whether uniform therapy schemes and a reduction in the medication available in the individual SAPV teams could lead to an improvement in patient care.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"317-327"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}