Schmerz最新文献

Geriatric patients are characterized by an advanced age and typical geriatric multimorbidity. The prevalence of pain increases with age. In geriatric patients in particular, pain is one of the most frequently occurring characteristic complexes. In Germany, a trend has been observed that the prevalence and intensity of pain in older people has continued to increase in recent years. Pain management in this particularly vulnerable group poses major challenges for the patients themselves, their relatives and healthcare professionals. For this reason, the expiring S3 guideline on "Pain assessment in older people in full inpatient care for the elderly" will be taken up, updated and expanded to include pain therapy and extended to outpatient and acute inpatient care.

Background: Higher pain grades are associated with high psychological burden and increase the risk for the persistence of chronic low back pain (CLBP).

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Chemotherapy-induced polyneuropathy (CIPN) encompasses a spectrum of symptoms ranging from hypoesthesia with impaired gait, stance and fine motor skills to painful dysesthesia and allodynia and significantly impairs the quality of life of those affected. In the present pilot study, quantitative sensory testing (QST) was used to investigate CIPN as a common adverse effect of cytostatic drugs in patients with incurable cancer. The QST is a standardized examination procedure that is not yet routinely used in cancer patients. It is used to examine thermal and mechanical perception and pain thresholds to record the subjectively experienced pain phenotype. In the N‑Check pilot project, the QST was used before and after tumor-specific, potentially CIPN-inducing treatment and the data collected was compared in a pre-post analysis. In addition, the specific effects of CIPN on the health-related quality of life of patients treated primarily with a palliative intention were recorded using the Functional Assessment for Cancer Therapy-General (FACT-G) questionnaire. Overall, the patients showed significant heat hypoalgesia after chemotherapy as a sign of damage to small nerve fibers. In addition, there were signs of deterioration of the quality of life. The feasibility of QST in patients with incurable cancer and palliative, neurotoxic chemotherapy was demonstrated in this pilot study.

Background: 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.

Aim: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Lumbar spinal canal stenosis primarily affects older individuals over 65 years old and is often associated with typical symptoms, such as spinal claudication. Aside from rare congenital causes, it usually develops secondarily due to age-related changes, such as disc protrusion, facet joint degeneration and ligament hypertrophy. Apart from the typical clinical symptoms, native upright X‑ray images in two planes and magnetic resonance imaging (MRI) are decisive. Patients without relevant neurological deficits should primarily undergo conservative treatment. In cases of pain that cannot be alleviated by conservative approaches, neurological deficits and ineffective conservative treatment the indications for surgical treatment can be justified. A minimally invasive decompression should be strived for whenever possible. A fusion can become necessary in the presence of a clinically relevant instability, stenosis or malalignment.