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[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。
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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 : 2024-10-17 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)。
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引用次数: 0
[What is health services research?] [什么是医疗服务研究?]
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-15 DOI: 10.1007/s00482-024-00843-9
Neeltje van den Berg, Wolfgang Hoffmann

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.

在医疗服务研究中,研究对象是日常条件下的居民医疗保健。科学问题包括医疗、以患者为导向、系统、绩效和质量相关以及卫生经济学等方面。在医疗服务研究中,通常会实施复杂的干预措施,例如包含多种治疗成分和/或跨越多个部门的治疗概念。医疗服务研究的设计以研究问题、环境和可用数据为基础,这些数据可以来自多种来源。
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引用次数: 0
[Interdisciplinary multimodal pain therapy: does the dose make a difference? : A comparison from routine clinical care]. [跨学科多模式疼痛疗法:剂量有区别吗? 常规临床护理比较]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-09 DOI: 10.1007/s00482-024-00838-6
Philipp Baumbach, Peter Storch, Thomas Weiss, Winfried Meissner, Fabian Rottstädt

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.

背景:跨学科多模式疼痛疗法(IMPT)是一种治疗严重慢性疼痛患者的成熟疗法。目的:本回顾性研究旨在比较短期住院治疗(SIT,1 周)和长期门诊治疗(LOT,4 周)IMPT 在重度慢性疼痛患者中的中期治疗效果,这两种治疗方法具有相似的治疗理念和治疗强度(20 小时/周):方法:两组患者均在 IMPT 开始和结束时以及 3 个月后填写德国疼痛问卷。主要结果指标包括随访时与疼痛相关的损伤和平均疼痛强度,这些指标与患者的性别、年龄以及治疗开始时的疼痛强度和损伤相当:结果:虽然两组患者最初在疼痛相关损伤和平均疼痛强度方面都显示出了明显的治疗效果,但在 3 个月的随访中,LOT 患者(32 人)与 SIT 患者(32 人)相比,在这两个变量上都有明显的改善。这是因为 LOT 患者的疗效持续良好,而 SIT 组的疗效则有所下降:结果表明,两种治疗方法都能观察到初步治疗效果,但较长的治疗时间似乎有利于治疗效果的长期稳定。
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引用次数: 0
[What determines the overall quality of postoperative pain management? A question of perspective]. [是什么决定了术后疼痛管理的整体质量?视角问题]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-08 DOI: 10.1007/s00482-024-00839-5
Paula Thomas, Thomas Weiss, Winfried Meissner, Philipp Baumbach

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.

背景:疼痛强度、疼痛相关干扰、副作用、(治疗)信息、参与度和个人互动等结果领域都被认为是围手术期疼痛管理的相关因素。目的:本横断面研究使用了一份新开发的调查问卷,以评估这些领域与患者的相关性,并比较与医护人员(HCP)的相关性:患者调查(n = 40)在德国耶拿大学医院术后第一天进行。为了调查群体差异,还招募了 63 名医护人员(学科:麻醉科 n = 15,外科 n = 17,护理部 n = 31)。调查问卷主要包括术后疼痛管理总体质量各领域之间的配对比较。每个领域的总分是主要的结果测量指标,使用广义估计方程对其进行分析:结果:在患者群体中,六个结果领域的优先级存在显著差异,个人互动的评分最高,其次是强度和干扰。患者和保健医生以及保健医生本身对各领域的看法也存在明显差异:研究表明,人际互动、减轻疼痛强度和干扰是患者术后疼痛管理体验的三个重要因素。然而,这三个因素与医护人员重视的因素之间的协调在多大程度上会对术后疼痛管理产生积极影响仍不清楚,应进一步研究。
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引用次数: 0
[Is health care research in an ivory tower?] [医疗保健研究是在象牙塔里吗?]
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-07 DOI: 10.1007/s00482-024-00841-x
Ursula Marschall
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引用次数: 0
[Our experience, our strength: patient involvement in health services research : Perspective of patient representatives on the Innovation Committee of the Federal Joint Committee]. [我们的经验,我们的力量:患者参与医疗服务研究:联邦联合委员会创新委员会患者代表的观点]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-04 DOI: 10.1007/s00482-024-00842-w
Susanne Bethge, Martin Danner, Sophie Schertell
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引用次数: 0
[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]. [德国姑息治疗专科门诊的疼痛管理 :一项横断面研究,介绍姑息治疗患者在家庭环境中的疼痛管理现状]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2023-02-08 DOI: 10.1007/s00482-023-00693-x
Christian Volberg, Julien Corzilius, Julian Maul, Astrid Morin, Martin Gschnell

Background: 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.

Objective: 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.

Material and methods: 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.

Results: 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.

Conclusion: 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.

背景:在专业门诊姑息治疗团队(德语缩写:SAPV)的帮助下,德国的重症患者和垂危患者可以在家中得到充分的照顾,直至生命的终结;然而,目前还没有统一的标准或指南来对疼痛进行良好的管理:这种方法是公共卫生研究领域的基础研究。目的:该方法是公共卫生研究领域的一项基础研究,旨在介绍各个 SAPV 团队在疼痛管理方面使用的方法(使用不同的专业团体、使用止痛药物、替代医疗等)。由此可以推断出哪些程序可被视为特别有效:这项横断面研究于 2021 年 5 月进行。研究人员通过邮件联系了德国姑息医学协会(DGP)主页上列出的所有德国SAPV团队(n = 307),并邀请他们参与研究。共有 175 个团队(57%)对请求做出了回应,并被纳入评估范围。评估进行了描述性数据分析:结果:德国门诊姑息治疗患者的疼痛管理基于多个组成部分。所有常见的镇痛药物都会使用,但主要处方药是作为非阿片类镇痛药的甲氰咪唑(99.4%)、阿片系列中的吗啡(98.3%)和作为联合镇痛药的普瑞巴林(96.6%)。如果疼痛治疗无效,22.5%的SAPV团队会定期实施姑息镇静以控制症状:这项横断面研究首次概括了德国门诊姑息治疗中的疼痛治疗方案。与国际研究相比,问题在于统一的治疗方案和减少各个姑息治疗小组的可用药物是否能改善对病人的护理。
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引用次数: 0
[How resilience can arise from chronic pain]. [慢性疼痛如何产生恢复力]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-23 DOI: 10.1007/s00482-024-00831-z
Cornelia Richter
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引用次数: 0
[Atlas block and alar ligament lesion-Underestimated or overrated?] [地图集阻滞和耳廓韧带病变--低估还是高估?]
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2023-07-19 DOI: 10.1007/s00482-023-00731-8
J Wölfle-Roos

Background: Disorders of the upper cervical spine, most notably lesions of the alar ligament and atlas block, are associated with numerous symptoms, especially as reported in the lay press. Thus, physicians are often confronted with patients who see in them a monocausal origin of complex complaints and hope for a quick remedy.

Objective: This review article presents the currently available evidence-based literature on atlas block and alar ligament lesions in order to adequately appreciate their significance.

Material and methods: Summary and critical evaluation of an extensive review of the literature on the diagnostics, clinical presentation, and treatment of disorders of the upper cervical spine.

Results: The current literature shows that alar ligament lesions are caused only by extremely high-speed trauma and that the reliability of their detection on magnetic resonance imaging (MRI) is moderate at best. As several studies have failed to demonstrate a correlation between symptoms and abnormalities of the alar ligaments on MRI, surgical stabilization of the upper cervical joints is not indicated. The diversity of symptoms associated with atlas block may be explained by the convergence of afferent neurons originating in C1-C3 on several cranial nerve nuclei found in neuroanatomical studies, but this association has yet to be proven. First studies show that highly significant improvements in cervical pain and range of motion can be achieved by means of manual therapy of the upper cervical spine with lasting effects even after 6 months.

Conclusion: The importance of alar ligament lesions has often been overrated in the past; however, a more nuanced multifactorial understanding of the disorder should be conveyed to the patient. An atlas block should be considered mainly as a possible cause of pain and restricted range of motion of the cervical spine and in this context manual therapy can be an effective treatment option.

背景:上颈椎的疾病,特别是椎韧带和寰椎阻滞的病变,与众多症状相关,尤其是在非专业媒体的报道中。因此,医生经常会遇到这样的病人,他们认为复杂的主诉是由单一病因引起的,并希望得到快速的治疗:这篇综述文章介绍了目前关于寰椎阻滞和耳廓韧带病变的循证文献,以充分认识其重要性:对有关上颈椎疾病的诊断、临床表现和治疗的大量文献进行总结和批判性评估:现有文献表明,耳廓韧带病变仅由极高速创伤引起,磁共振成像(MRI)对其检测的可靠性充其量为中等。由于多项研究未能证明症状与磁共振成像上的椎间韧带异常之间存在相关性,因此不建议通过手术来稳定上颈椎关节。神经解剖学研究发现,源自 C1-C3 的传入神经元汇聚于多个颅神经核,这可能解释了寰椎阻滞相关症状的多样性,但这种关联性尚待证实。首次研究表明,通过对上颈椎进行手法治疗,颈椎疼痛和活动范围可以得到非常明显的改善,甚至在 6 个月后仍有持续效果:结论:过去,人们常常高估椎弓根韧带病变的重要性;然而,应向患者传达对这一疾病更细致入微的多因素认识。寰椎阻滞主要应被视为导致颈椎疼痛和活动范围受限的可能原因,在这种情况下,手法治疗不失为一种有效的治疗方法。
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引用次数: 0
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