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[Body, mind and culture : The complex dimensions of experiencing pain]. [身体、心灵与文化:体验痛苦的复杂层面]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-01-30 DOI: 10.1007/s00482-023-00787-6
Jonas Tesarz

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.

本文论述的是身体、精神和文化在健康和生病方面的相互关系。如果不仅要治疗疾病,还要治疗病人,那么不仅要了解疾病的躯体和心理层面,还要了解疾病的 "文化 "层面。本文以个人思考为基础,以重点文献检索为补充,深入探讨了文化影响如何不仅影响疾病体验,而且决定个人和社会如何对待疾病。此外,文章还指出,不仅是生病,生病的身体也可以从躯体、心理和文化层面来理解,而且必须区分身体的生理状态和主观感受。最后,还深入分析了躯体心理和心身相互作用的复杂性,从而说明精神压力如何导致身体疼痛,以及身体疼痛如何成为精神压力源。
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引用次数: 0
[Emotions in chronic pain : Changes in the course of day clinic interdisciplinary multimodal pain therapy]. [慢性疼痛中的情绪:日间诊所跨学科多模式疼痛治疗过程中的变化]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2023-08-29 DOI: 10.1007/s00482-023-00748-z
Anne Juliane Körner, Rainer Sabatowski, Ulrike Kaiser

Research question: 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).

Methods: 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.

Results: 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 (χ2ECQ_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).

Discussion: 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.

研究问题:本研究探讨了在跨学科多模式疼痛治疗(IMPT)过程中,慢性疼痛患者的情感体验和情感能力(EC)的变化程度:研究对象包括 N = 184 名成年德语非癌症相关慢性疼痛患者。他们完成了日间诊所的 IMPT。在三个测量时间点,使用情绪能力自我评估问卷(ERSQ-ES)和情绪能力问卷(ECQ)对特定情绪(愤怒等)和EC的频率进行评估。对课程结果进行了描述性分析、推断分析和线性回归分析:结果:积极情绪的体验频率更高(效应大小 r = 0.40; p 2ECQ_total (2) = 0.09; p = 0.956)。EC在很大程度上解释了积极情绪体验频率(R2 = 0.468)和消极情绪体验频率(R2 = 0.390)的差异:讨论:在 IMPT 过程中,患者报告的积极和消极情绪频率均有所改善。进一步的研究应使用对照组来验证这些结果。尽管研究对象的能力没有明显提高,但EC对情绪频率有很高的预测价值。未来的治疗设计和评估应更加关注情绪体验的变化。
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引用次数: 0
[Pain-related stigma in patients with breast, colon, prostate or lung cancer : Results of a bicentric register-based cross-sectional study]. [乳腺癌、结肠癌、前列腺癌或肺癌患者与疼痛相关的耻辱感:基于双中心登记的横断面研究结果]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2023-09-14 DOI: 10.1007/s00482-023-00752-3
A Roicke, P Esser, B Hornemann, J Ernst

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

背景:有关癌症患者的研究表明,癌症患者的鄙视感与癌症相关性较高。然而,还没有研究探讨过与癌症相关疼痛有关的鄙视感。在这项工作中,我们分析了四大癌症实体的大量样本中疼痛与感知到的鄙视之间的关系:在一项基于登记的双中心研究中,我们对 858 名乳腺癌、肠癌、肺癌和前列腺癌患者(45.6% 为女性,平均年龄 60.7 岁)的定量数据进行了评估。通过社会影响量表(SIS-D)(包括一个总分和四个分量表)对患者的鄙视感进行了测量。疼痛通过简短疼痛量表(BPI)进行评估。数据分析采用了与各种社会人口学和医学预测因素的相关性和多元回归法:结果:在所有 858 名癌症患者中,肺癌和乳腺癌患者的疼痛程度最高。疼痛的强度是乳腺癌和结直肠癌患者感受到的耻辱感的预测因素。此外,年龄较小也是导致患者感到耻辱的一个因素。良好的生活质量是一个保护因素。除肺癌患者外,最终模型显示出较高的拟合度(相关系数 R2 > 0.35):我们的研究结果支持这样的假设,即疼痛体验会对癌症患者的鄙视感产生影响。抑郁症可能会影响患者的鄙视感。因此,在临床实践中,这部分患者应得到特别关注和肿瘤心理治疗。此外,还需要进一步研究与疼痛相关的鄙视感的过程和作用机制。
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引用次数: 0
[Concept-dependent and -independent care effects of site-specific care concepts using "pain" as an example]. [以“疼痛”为例的特定地点护理概念的概念依赖性和独立性护理效果]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2023-09-29 DOI: 10.1007/s00482-023-00754-1
Sarah Peuten, Birgit Jaspers, Irmtraud Hainsch-Müller, Christoph Aulmann, Werner Schneider, Lukas Radbruch, Gülay Ateş

Background: 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).

Methods: 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.

Results: 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.

Discussion: 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.

背景:在两个地点调查了有姑息治疗需求的患者的姑息治疗结构、跨部门过渡和护理途径。以“疼痛”为例,对相似性和差异进行系统比较,旨在提供与特定地点姑息治疗概念(综合和合作)相关程度的信息。方法:本研究采用混合方法设计。除了对匿名患者记录(n = 774),专家访谈(n = 20) ,以及对患者、亲属(n = 60)和焦点组(n = 12) ,进行了。结果:系统比较分析为综合或合作姑息治疗中概念独立的共性(如社会人口分布、加重疼痛治疗)以及概念依赖性差异(如护理途径、通过综合护理结构促进持续症状控制)提供了证据。讨论:正如本文所关注的,疼痛主题及其组织管理的共同点和差异随着各自组织结构(=概念依赖性)以及概念独立的外部影响因素的影响而变得明显。
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引用次数: 0
["I feel reborn": a holistic view of pain]. [我感到重生":对疼痛的整体看法】。]
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-11-19 DOI: 10.1007/s00482-024-00848-4
Eva-Maria Holzinger, Gustav von Blanckenburg
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引用次数: 0
[Factors influencing analgesic use patterns in patients with chronic tumor-associated pain. : A qualitative pilot study considering different groups of medications]. 影响慢性肿瘤相关性疼痛患者镇痛药使用模式的因素。一项考虑不同药物组的定性初步研究]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2023-11-13 DOI: 10.1007/s00482-023-00765-y
Marco Richard Zugaj, Andrea Züger, Jens Keßler

Background: 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.

Methods: 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.

Results: 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.

Discussion: 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.

背景:由于肿瘤特异性治疗的提高,肿瘤患者的生存时间越来越长,疼痛是常见的症状。肿瘤相关慢性疼痛的金标准是多模式治疗。不遵守规定会导致高昂的费用,并可能使患者处于危险之中。本研究旨在探讨肿瘤相关性慢性疼痛患者的依从性行为和主观治疗依从性。重点在于病人的观点。包括不同的药物组,如NOPA、阿片类药物、共镇痛药和大麻素,以及非药物治疗。方法:采用质性研究方法对10例慢性肿瘤疼痛患者进行半结构化引导访谈。这些采访都被录了下来。根据库卡兹和Rädiker的观点,评估采用了集中的内容结构访谈分析。结果:确定了5个主要分类。基于研究问题的中心类别是"从患者角度看的依从性行为"“药物治疗”类别构成了研究的框架。其他主要类别包括“病史”、“与治疗提供者的关系”和“态度和信念”。总共形成和解释了77个额外的子类别。从患者的角度来看,不同用药组的依从性行为存在差异。姑息环境影响治疗决定和依从性。使用的药物治疗方案是复杂和动态的,特别是当有多个从业人员参与时。此外,大麻素的使用也存在歧义。非药物治疗被患者边缘化。从接受采访的患者的角度来看,并不是治疗提供者影响了他们的依从性行为,而是他们自己的经历、态度和信念。讨论:本研究平等地纳入了所有药物组和非药物治疗,在定性设置上补充了以前的文献。既往研究中已知的依从性因素反映在肿瘤疾病后慢性疼痛患者群体的主观感知中。非药物治疗方法的边缘化可以解释为,多模式治疗方法很少经常使用和控制在慢性阶段。因此,药物和非药物治疗应该更加一致地应用于肿瘤相关疼痛患者。
{"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":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Surgical treatment of trigeminal pain]. [三叉神经痛的手术治疗]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1007/s00482-024-00835-9
Rezvan Ahmadi, Volker Martin Tronnier

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).

治疗神经性疼痛(包括三叉神经痛)的手术分为三类:减压、消融和神经调控。微血管减压术是治疗三叉神经痛的唯一病因疗法,适用于因血管神经冲突引起的典型三叉神经痛。消融术包括经皮和放射外科方法,主要用于特发性三叉神经痛。对于三叉神经的不可逆神经病变,应考虑其他神经病理性疼痛的算法,以及可能使用的神经调节技术。在选择疗法时,必须将诊断、药物副作用、患者的个体风险和治疗效果都考虑在内(德国神经病学学会当前的 S1 指南)。
{"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":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Current knowledge among German physiotherapists on the subject of pain]. [德国物理治疗师对疼痛问题的认识现状]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-08 DOI: 10.1007/s00482-024-00846-6
T Reißner, A Bassimtabar

Background: 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.

Aim: This study aimed to evaluate the pain-related knowledge and postural-structural-biomechanical (PSB) beliefs regarding pain among physiotherapists practicing in Germany.

Method: 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.

Results: 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).

Conclusion: 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.

背景:疼痛是肌肉骨骼医疗保健领域无处不在的症状。根据目前的科学建议,以人为本的护理需要全面的、以证据为基础的疼痛知识。目的:本研究旨在评估德国物理治疗师对疼痛的相关知识和姿势-结构-生物力学(PSB)信念:方法:使用 SoSci Survey 对 n = 105 名物理治疗师进行了在线调查,其中包括德文版疼痛神经生理学修订问卷 (rNPQ-D) 和疼痛基本知识问卷 (EKPQ)。当至少 90% 的参与者正确回答 12 个问题中的至少 8 个问题时,即为满意结果。此外,还调查了参与者的 "学历 "和 "工作经验 "这两个变量对问卷得分可能产生的影响:rNPQ-D 的平均得分为 70.8 ± 15.4% (95% CI: 67.8-73.8%)。EKPQ 的平均得分为 51.4 ± 26% (95% CI: 46.4-56.4%)。rNPQ-D(69.5% 的参与者;n = 73)和 EKPQ(30.6% 的参与者;n = 32)的结果均不令人满意。两份问卷的得分呈中度正相关,在统计学上具有显著性(r = 0.47;p 5 年专业经验):在德国,物理治疗师对疼痛的认识似乎还不够,而且非常偏向于 PSB。此外,与职业物理治疗培训课程的毕业生相比,接受过学术培训的治疗师似乎对疼痛的理论和病例知识掌握得更多。为了确保今后对疼痛患者进行成功有效的治疗,必须系统地研究造成这种缺陷的潜在原因。德国的疼痛物理治疗应努力实现系统性变革,以循证实践为基础。
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引用次数: 0
[Validity of the Chronic Pain Grade Scale in nonspecific chronic low back pain]. [慢性疼痛等级量表在非特异性慢性腰背痛中的有效性]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-07 DOI: 10.1007/s00482-024-00844-8
Petra Hampel, Anna Maria Hüwel

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.

背景:疼痛等级越高,心理负担越重,慢性腰背痛(CLBP)持续存在的风险也越大:目的:以前关于慢性疼痛分级量表(CPGS)标准有效性的研究结果已经扩展到住院患者多学科骨科康复(MOR)中,并增加了额外的社会心理和工作相关测量:在这项多中心研究中,研究人员按照疼痛等级(I-IV 级)对 1010 名患有非特异性 CLBP(ICD-10:M51/53/54)的患者在开始住院 MOR 之前的心理、工作和疼痛相关结果进行了调查。此外,研究人员还调查了按疼痛等级划分的患者疼痛特异性自我效能感、抑郁和有偿就业主观预后的评分频率分布:所有疼痛等级的 CPGS 在心理、工作和疼痛相关结果方面的差异均在预期范围内。在事后配对比较中,IV 级与较低级别的患者有显著差异。疼痛等级较高的患者在心理社会参数方面表现出不利的水平,在临床范围内得分的频率也高于预期:这些结果证实了 CPGS 的标准有效性。在较高疼痛等级中观察到的社会心理风险模式支持了早期进行疼痛相关和心理诊断评估以及系统地分配以需求为基础的跨学科多模式治疗的重要性。
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引用次数: 0
[Health services research in acute pain medicine : Where do we come from in Germany?] [急性疼痛医学的医疗服务研究:我们从德国哪里来?]
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-06 DOI: 10.1007/s00482-024-00845-7
Nadja Nestler, Christoph Maier, Jürgen Osterbrink

Background: 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.

Aim: 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.

Material and methods: 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.

Results: 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.

Conclusion: 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.

背景:直到本世纪初,人们一直在强调优化医院急性疼痛治疗的必要性。在优化过程中只取得了少数成功。由于德国的急性疼痛治疗仍不尽如人意,因此启动了首个疼痛医学医疗服务研究项目。目的:为了说明德国疼痛医学领域医疗服务研究的开端,介绍了 "无痛医院 "和 "明斯特市无痛行动联盟 "研究项目以及 Certkom 认证倡议:材料和方法:对患者疼痛护理和跨学科疼痛管理的现状进行了分析,提出了优化措施,并对所有项目的实施和后续评估进行了综合干预:结果:通过对现状的系统调查、有针对性的规划和优化措施的引入,所有项目都能改善对病人的护理。相应的评估可以证明这些成果:结论:项目中的系统性方法以及对实际护理中科学数据的整理实现了急性疼痛管理的优化。为德国进一步开展疼痛治疗方面的医疗保健研究奠定了基础;然而,这些项目也暴露出在纳入弱势病人群体方面的局限性。
{"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}
引用次数: 0
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Schmerz
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