Schmerz最新文献

Cluster headache is a severe primary headache disorder, which can be associated with a substantial impairment for sufferers. The Cluster Headache Impact Questionnaire (CHIQ) is a short questionnaire for measuring the cluster headache-specific impairment. A 5-stage severity grading from "no to low impairment" to "'extreme impairment" was established based on the results of an English-speaking patient collective. The present article tested whether the severity classification can be transferred to a German patient group. Data from 196 patients with episodic and chronic cluster headache were examined during an active episode. The severity grading classification of the CHIQ also showed clinically relevant results in the German collective, i.e., the five degrees of severity showed significant differences with respect to attack frequency, intake of acute medication and unspecific headache-related impairment (HIT-6) and quality of life (SF-12v2). Interestingly, 32 out of 52 patients with episodic cluster headache outside the active epísode suffered an impairment above the lowest severity grade, i.e., at least a moderate impairment. In conclusion, the CHIQ provides a short instrument to document the current impairment in cluster headache patients. The severity grading classification presented here facilitates the clinical interpretation.

Background: The COVID-19 pandemic led to significantly restricted access to pain medicine services. Patients with cancer-related pain are considered a vulnerable group in terms of care deficits. A questionnaire among providers providing treatment to this group was used to assess limitations and solutions in this critical situation.

Materials and methods: The online survey, developed by the 'Tumour Pain Working Group' of the German Pain Society using the Delphi method, included questions on site structure, pandemic-related care problems, and burdens experienced by those treating patients. It was distributed several times via the mailing lists of the German Pain Society and the 'Palliative Medicine Working Group' of the German Society of Anaesthesiology and Intensive Care Medicine.

Results: In all, 175 fully completed questionnaires were analysed. Over 75% of participants reported pandemic-related staff shortages and closures of pain medicine facilities, with 32% of facilities temporarily not treating elective pain patients and 13% not treating any emergencies. Care was hampered by numerous logistical problems such as very frequent pandemic-related cancellations by patients or in the transmission of prescriptions. Alternative forms of consultation by telephone or telemedicine, rarely used before the pandemic, were reported by 79 and 31% of respondents respectively, but deficiencies were noted. In addition, 52.1% of respondents complained of severe and 26.8% of moderate psychological stress due to the pandemic, and 74.1% evaluated working conditions as moderately to severely difficult. Medical training was still possible for 86% through format changes.

Conclusion: The COVID-19 pandemic revealed numerous deficits in the care of patients with cancer-related pain, as well as burdens on healthcare providers. The development of new concepts could help to ensure better care in future crisis situations.

Background and objectives: Chronic pain affects an enormous number of patients in Germany. Therefore, early detection is important using easy, quick and reasonable screening methods. The avoidance-endurance fast screen is currently available in two different versions: one asking for pain-related behaviour in light and severe pain and the other assessing overall severe pain-related behaviour. In this study we aim to examine the agreement between both scales and for the first time describe the role of protective psychological features such as resilience and self-compassion in this model.

Materials and methods: Epidemiological cross-sectional study (n = 278) of a healthy cohort occasionally experiencing pain (< 3 months). The analysis was done using standard descriptive statistics, correlations (Spearman's rho) and deductive statistics (t-tests and one-factor ANOVA with post hoc Bonferroni correction) and effect sizes (Cohen's d). Matching of the instruments was calculated with Cohen's kappa.

Results: The results showed a moderate agreement for the two versions. A validity check of the subgroups resulted in comparable findings. The one-level version scored higher in terms of pain persistence which caused subgroup changes from adaptive to eustress-endurance responses and from fear-avoidance to distress-endurance responses. The distress-endurance subgroup had significantly lower values of the trait self-compassion.

Conclusions: Based on the results of this study, the quality of agreement between the two AEFS versions is considered strong. Without the comparison between mild and strong pain, endurance behaviour was reported more often. According to these findings, overestimation of pain persistence behaviour using the one-level version might result. Therefore, future studies should re-evaluate the cut-offs. As reported in previous studies, protective psychological features showed the highest scores in the eustress-endurance subgroup.

Performing regional anesthesia procedures in patients with coagulation disorders or under antithrombotic medication requires careful consideration of the benefits and risks. This review article compares international guidelines on regional anesthesia under anticoagulation and discusses the different approaches for peripheral and neuraxial procedures. In addition, the importance of point-of-care testing (POCT) procedures for monitoring anticoagulants and their influence on making decisions is highlighted. A particular focus is on practical recommendations for action for the clinical application in order to enable evidence-based and safe regional anesthesia under anticoagulation.

Background: 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.

Objectives: 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.

Materials and methods: A standardised online questionnaire was used to survey members via cooperating scientific societies and organisations.

Results: 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.

Conclusions: 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.

Background: 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.

Aim: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Background: Educational strategies that improve understanding of pain can influence the behaviour of patients with chronic low back pain. One such strategy is pain neuroscience education (PNE), which is increasingly being used in chronic low back pain rehabilitation. However, little is known about its influence on psychosocial factors. Thus far, PNE has primarily been considered in terms of pain reduction and the alleviation of disability in the treatment of patients with chronic low back pain.

Aim: The aim of this scoping review was to summarise the findings of randomised controlled trials on the quality-of-life outcomes of PNE interventions for this population.

Methods: A systematic literature search was carried out in the Medline (PubMed), PEDro and Cochrane Library databases between 1 May and 15 May 2024, with an update on 3 June 2025. Based on the defined inclusion and exclusion criteria, three randomised controlled trials (RCTs) were selected for analysis of the quality-of-life outcome parameter. The revised version of the Cochrane tool for assessing the risk of bias in randomised trials (RoB 2) was used to evaluate the studies' methodological quality. This scoping review's methodology followed the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Results: In all three included RCTs, the PNE intervention resulted in improved Short Form-36 (SF-36) scores. However, one RCT with a low risk of bias found no significant advantage to additional PNE treatment compared to physiotherapy alone. A second RCT raised concerns about the risk of bias; in this study, PNE treatment was superior to a conventional educational intervention. The third RCT, which had a high risk of bias, observed significant improvements in quality of life after both PNE treatment and myofascial induction therapy (MIT). However, the outcome was significantly better with MIT.

Conclusion: Overall, the evidence supporting the use of PNE to improve quality of life in patients with chronic low back pain is weak. Therefore, it remains unclear whether PNE can be used to achieve this goal. Further RCTs with subsequent systematic reviews are needed to make clear recommendations for practitioners.

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.