Schmerz最新文献

{"title":"[Opioid prescriptions for insured individuals without cancer in Germany: data from the BARMER].","authors":"Veronika Lappe, Daniel Grandt, Ursula Marschall, Frank Petzke, Winfried Häuser, Ingrid Schubert","doi":"10.1007/s00482-024-00852-8","DOIUrl":"https://doi.org/10.1007/s00482-024-00852-8","url":null,"abstract":"<p><strong>Background: </strong>The importance of opioids in the treatment of non-cancer pain is under debate. No current data are available from Germany on the prevalence of opioid treatment for non-cancer pain.</p><p><strong>Aim of the study: </strong>Data on the prevalence of short- and long-term opioid prescriptions for patients without cancer, prescribed agents, co-medication, specialty of prescribing physicians, demographic and clinical characteristics of patients.</p><p><strong>Materials and methods: </strong>Retrospective analysis of billing data of adult BARMER-insured persons without evidence of cancer (N = 6,771,075) in 2021 and for patients initiating opioid therapy in 2019 (n = 142,598).</p><p><strong>Results: </strong>In total, 5.7% of the insured persons without a cancer diagnosis received at least one prescription for an opioid in 2021, while 1.9% received long-term therapy. Tilidine and tramadol were the most frequently prescribed opioids in short- and long-term therapy. Women received opioids more frequently than men. The frequency of prescriptions significantly increased with age. In 2021, 22.5% of insured persons with long-term opioid therapy received a co-medication with pregabalin and/or gabapentin, 37.5% with an antidepressant and 58.1% with metamizole and/or NSAIDs. A total of 59.5% of first prescriptions were issued by general practitioners. In the first year of therapy, an average of 2.1 practices were involved in prescribing analgetics for people on long-term opioid therapy and 13 different chronic diseases were documented.</p><p><strong>Discussion: </strong>Opioid therapy for non-cancer-related pain is predominantly carried out by general practitioners in older and multi-morbid patients. The indication for or against opioid therapy requires shared decision-making with patients and, if necessary, their relatives, as well as a review of possible drug interactions.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786850","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":"[Professional development and job satisfaction in pain medicine].","authors":"Joachim Erlenwein, Benedikt Kube, Dirk Boujong, Joachim Nadstawek, Michael Hüppe, Tim P Jürgens, Winfried Meißner, Frank Petzke","doi":"10.1007/s00482-024-00851-9","DOIUrl":"https://doi.org/10.1007/s00482-024-00851-9","url":null,"abstract":"<p><strong>Background: </strong>Pain medicine is an interdisciplinary and interprofessional field of specialisation. Due to concerns about new recruits and an aging workforce, especially among physicians, it is important to better understand professional and career pathways in pain medicine.</p><p><strong>Objectives: </strong>The aim of this study was to record the occupational routes of people working in an institution specialised in pain medicine/pain management as well as their motivation and job satisfaction.</p><p><strong>Materials and methods: </strong>A standardised online questionnaire was used to survey members via cooperating scientific societies and organisations.</p><p><strong>Results: </strong>Data from 398 physicians, 78 psychologists, 62 physiotherapists, three occupational therapists and 23 nursing professionals were included in the analysis. The age distribution skewed towards higher age groups, with the majority of respondents aged between 51 and 60 years. The respondents usually first came into clinical contact with pain medicine after many years of work. In the case of physicians in particular, there was a delay of almost a decade after their licence to practise. With regard to motivational factors, intrinsic aspects were rated higher than monetary ones. Work-life balance issues tended to be in the middle of the ranking. Regarding job satisfaction in pain medicine, the overall satisfaction of the respondents was high, with the lowest satisfaction ratings being given in the categories \"opportunities for further career development\", \"additional income options\" and \"recognition by superiors\". A significant proportion of respondents (1/3) stated that career changes were forthcoming-changes outside a pain medicine setting or in particular retirement.</p><p><strong>Conclusions: </strong>The results emphasise the critical perspectives regarding the future provision of care for people with chronic pain. The results provide, for the first time, an insight into the career routes of staff in the field of pain medicine and their motivations and job satisfaction, which should be considered in the discussion about ensuring personnel resources in the future.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771960","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":"[Body, mind and culture : The complex dimensions of experiencing pain].","authors":"Jonas Tesarz","doi":"10.1007/s00482-023-00787-6","DOIUrl":"10.1007/s00482-023-00787-6","url":null,"abstract":"<p><p>This article deals with the interrelationship between body, mind and culture with respect to being healthy and being ill. If one wants to treat not only sickness but also sick people, it is helpful to be aware not only of the somatic and psychological dimensions of a disease but also of the \"cultural\" dimension of a disease. Based on personal reflections and supplemented by a focused literature search this article provides insights into how cultural influences not only affect the experience of illness but also decide how an illness is dealt with individually and socially. Furthermore, it is shown that not only being sick but also the sick body can be understood in somatic, psychological and cultural dimensions and that a distinction must be made between the body as it physically is and as it is subjectively perceived. Finally, an insight into the complexity of the somatopsychic and psychosomatic interactions is provided in order to derivatively show how mental stress can lead to physical pain and physical pain can become a mental stressor.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"382-389"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576693","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":"[Emotions in chronic pain : Changes in the course of day clinic interdisciplinary multimodal pain therapy].","authors":"Anne Juliane Körner, Rainer Sabatowski, Ulrike Kaiser","doi":"10.1007/s00482-023-00748-z","DOIUrl":"10.1007/s00482-023-00748-z","url":null,"abstract":"<p><strong>Research question: </strong>The present study examined the extent to which emotional experience and emotional competence (EC) change in people with chronic pain during interdisciplinary multimodal pain treatment (IMPT).</p><p><strong>Methods: </strong>The study included N = 184 adult German-speaking individuals with non-cancer-related chronic pain. They completed a day clinic IMPT. The frequency of specific emotions (anger, etc.) and EC was assessed at three measurement time points using the Questionnaire for Emotion-Specific Self-Assessment of Emotional Competencies (ERSQ-ES) and the Emotional Competency Questionnaire (ECQ). The course results were analyzed descriptively, inferentially, and using linear regression.</p><p><strong>Results: </strong>Positive emotions were experienced more frequently (effect size r = 0.40; p < 0.001) and negative emotions less frequently (r = 0.39, p < 0.001) at end of therapy. The experience of anger decreased particularly strongly (r = 0.52; p < 0.001). Self-assessed EC did not change during the IMPT (χ²_{ECQ_total} (2) = 0.09; p = 0.956). EC largely explained the variance in the frequency experience of positive (R² = 0.468) and negative emotions (R² = 0.390).</p><p><strong>Discussion: </strong>Improvements in patient-reported frequencies of positive and negative emotions during IMPT were demonstrated. Further research should validate these results using a control group. Even though no explicit increase in competence was perceivable for the studied subjects, EC had a high predictive value for emotion frequency. Future therapy designs and evaluations should focus more on changes of emotional experience.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"400-408"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112472","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":"[Pain-related stigma in patients with breast, colon, prostate or lung cancer : Results of a bicentric register-based cross-sectional study].","authors":"A Roicke, P Esser, B Hornemann, J Ernst","doi":"10.1007/s00482-023-00752-3","DOIUrl":"10.1007/s00482-023-00752-3","url":null,"abstract":"<p><strong>Background: </strong>Studies on cancer patients show a moderately high relevance of perceived stigmatization. However, no studies have explored the perceived stigmatization in relation to cancer-associated pain. In this work, we analysed the relationship between pain and perceived stigmatization across a large sample of four major cancer entities.</p><p><strong>Methods: </strong>Quantitative data of 858 patients (45.6% women, mean age 60.7 years) with breast, bowel, lung and prostate cancer were evaluated in a register-based, bicentric study. Perceived stigmatization was measured using the social impact cale (SIS-D), including a total score and four subscales. Pain was assessed with the brief pain inventory (BPI). The data were analysed using correlation und multiple regression with various sociodemographic and medical predictors.</p><p><strong>Results: </strong>Of all 858 cancer patients, those with lung and breast cancer were characterized by the greatest pain. The intensity of the pain was a predictor of the perceived stigma in patients with breast and colorectal cancer. In addition, younger age was also a predictor for perceived stigmatization. A good quality of life resulted as a protective factor. The final models showed a high goodness of the fit (corr. R² > 0.35), except for the lung cancer patients.</p><p><strong>Conclusions: </strong>Our findings support the assumption that the experience of pain can have an impact on the perceived stigmatization of cancer patients. Depression might influence the perceived stigmatization. Therefore, this group of patients should receive special attention and psycho-oncological care in clinical practice. Further research on the course and mechanisms of action of pain-related perceived stigmatization is also required.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"390-399"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297166","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":"[Concept-dependent and -independent care effects of site-specific care concepts using \"pain\" as an example].","authors":"Sarah Peuten, Birgit Jaspers, Irmtraud Hainsch-Müller, Christoph Aulmann, Werner Schneider, Lukas Radbruch, Gülay Ateş","doi":"10.1007/s00482-023-00754-1","DOIUrl":"10.1007/s00482-023-00754-1","url":null,"abstract":"<p><strong>Background: </strong>Structures of palliative care, cross-sectoral transitions and care pathways of patients with palliative care needs were investigated at two sites. The systematic comparison of similarities and differences using the topic of 'pain' as an example is intended to provide information on the extent to which these are related to site-specific palliative care concepts (integrated and cooperative).</p><p><strong>Methods: </strong>The study follows a mixed-methods design. In addition to a document analysis of anonymised patient records (n = 774), expert interviews (n = 20), as well as interviews with patients, relatives (n = 60) and focus groups (n = 12), were conducted.</p><p><strong>Results: </strong>The systematic comparative analysis provides evidence for concept-independent commonalities (e.g. sociodemographic distribution, aggravated pain treatment) as well as concept-dependent differences (e.g. care pathways, facilitated continuous symptom control through integrated care structures) in the context of integrated or cooperative palliative care.</p><p><strong>Discussion: </strong>Commonalities and differences with regard to the topic of pain, as focused on here, and its organisational management become tangible as effects of the respective organisational structure (= concept-dependent) as well as concept-independent external influencing factors.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"433-440"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41140284","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":"[\"I feel reborn\": a holistic view of pain].","authors":"Eva-Maria Holzinger, Gustav von Blanckenburg","doi":"10.1007/s00482-024-00848-4","DOIUrl":"10.1007/s00482-024-00848-4","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":"38 6","pages":"379-381"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668979","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":"[Surgical treatment of trigeminal pain].","authors":"Rezvan Ahmadi, Volker Martin Tronnier","doi":"10.1007/s00482-024-00835-9","DOIUrl":"10.1007/s00482-024-00835-9","url":null,"abstract":"<p><p>Surgical procedures for treating neuropathic pain, including trigeminal neuralgia (TGN), are categorized into three groups: decompression, ablation, and neuromodulation. Microvascular decompression is the only causal therapy for TGN, applicable favorably in cases of classical TGN due to a vascular nerve conflict. Ablative procedures include both percutaneous and radiosurgical methods, which are mainly used for idiopathic trigeminal neuralgia. For irreversible neuropathies of the trigeminal nerve, the algorithm for other neuropathic pain conditions should be considered, along with the potential use of neuromodulatory techniques. When selecting a therapy, diagnosis, medication side effects, individual patient risks, and treatment outcomes must all be taken into account (current S1 guideline from the German Society of Neurology).</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"441-448"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473711","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":"[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}