Pub Date : 2024-10-15DOI: 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.
{"title":"[What is health services research?]","authors":"Neeltje van den Berg, Wolfgang Hoffmann","doi":"10.1007/s00482-024-00843-9","DOIUrl":"https://doi.org/10.1007/s00482-024-00843-9","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473712","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}
Pub Date : 2024-10-09DOI: 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。
{"title":"[Interdisciplinary multimodal pain therapy: does the dose make a difference? : A comparison from routine clinical care].","authors":"Philipp Baumbach, Peter Storch, Thomas Weiss, Winfried Meissner, Fabian Rottstädt","doi":"10.1007/s00482-024-00838-6","DOIUrl":"https://doi.org/10.1007/s00482-024-00838-6","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392995","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}
Pub Date : 2024-10-08DOI: 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。
{"title":"[What determines the overall quality of postoperative pain management? A question of perspective].","authors":"Paula Thomas, Thomas Weiss, Winfried Meissner, Philipp Baumbach","doi":"10.1007/s00482-024-00839-5","DOIUrl":"https://doi.org/10.1007/s00482-024-00839-5","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392997","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}
Pub Date : 2024-10-07DOI: 10.1007/s00482-024-00841-x
Ursula Marschall
{"title":"[Is health care research in an ivory tower?]","authors":"Ursula Marschall","doi":"10.1007/s00482-024-00841-x","DOIUrl":"https://doi.org/10.1007/s00482-024-00841-x","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392996","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}
Pub Date : 2024-10-04DOI: 10.1007/s00482-024-00842-w
Susanne Bethge, Martin Danner, Sophie Schertell
{"title":"[Our experience, our strength: patient involvement in health services research : Perspective of patient representatives on the Innovation Committee of the Federal Joint Committee].","authors":"Susanne Bethge, Martin Danner, Sophie Schertell","doi":"10.1007/s00482-024-00842-w","DOIUrl":"https://doi.org/10.1007/s00482-024-00842-w","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372769","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}
Pub Date : 2024-10-01Epub Date: 2023-02-08DOI: 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.
{"title":"[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].","authors":"Christian Volberg, Julien Corzilius, Julian Maul, Astrid Morin, Martin Gschnell","doi":"10.1007/s00482-023-00693-x","DOIUrl":"10.1007/s00482-023-00693-x","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"317-327"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725235","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}
Pub Date : 2024-10-01Epub Date: 2024-09-23DOI: 10.1007/s00482-024-00831-z
Cornelia Richter
{"title":"[How resilience can arise from chronic pain].","authors":"Cornelia Richter","doi":"10.1007/s00482-024-00831-z","DOIUrl":"https://doi.org/10.1007/s00482-024-00831-z","url":null,"abstract":"","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":"38 5","pages":"301-303"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294424","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}
Pub Date : 2024-10-01Epub Date: 2023-07-19DOI: 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.
{"title":"[Atlas block and alar ligament lesion-Underestimated or overrated?]","authors":"J Wölfle-Roos","doi":"10.1007/s00482-023-00731-8","DOIUrl":"10.1007/s00482-023-00731-8","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>This review article presents the currently available evidence-based literature on atlas block and alar ligament lesions in order to adequately appreciate their significance.</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"352-358"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9840382","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}
Pub Date : 2024-10-01Epub Date: 2024-01-15DOI: 10.1007/s00482-024-00788-z
Kristin Kieselbach, Ursula Frede
If we understand chronic pain not only as a disease but also as an existential crisis, it seems logical and reasonable to consider spiritual aspects in the treatment process. Spirituality is understood as an umbrella term for all activities and experiences that give meaning and significance to people's lives-irrespective of their religious affiliation. So far, spiritual aspects have been considered therapeutically mainly in the palliative context. According to current survey-based studies of pain patients, the inclusion of spiritual themes in therapy leads to an improvement in quality of life and pain tolerance and is moreover explicitly desired by those patients. A consistent expansion of multimodal treatment approaches in the sense of a biopsychosocial-spiritual concept has not yet been implemented. The following basic attitudes and behaviors are relevant for practical implementation: openness to spiritual themes and authenticity, taking a spiritual history, listening, standing firm, activation of values, use of motives from religion, mythology, and art. Professional competence generally involves all practitioners, but may also require qualified professionals for specialized assistance. The integration of authentic spiritual assistance into multimodal pain management should help to stabilize self-esteem and the experience of identity of the patients through resource activation and identification of burdensome spiritual beliefs. The detailed integration and investigation of the efficiency of spiritual interventions in multimodal pain therapy require further research.
{"title":"[Spiritual interventions in multimodal pain management].","authors":"Kristin Kieselbach, Ursula Frede","doi":"10.1007/s00482-024-00788-z","DOIUrl":"10.1007/s00482-024-00788-z","url":null,"abstract":"<p><p>If we understand chronic pain not only as a disease but also as an existential crisis, it seems logical and reasonable to consider spiritual aspects in the treatment process. Spirituality is understood as an umbrella term for all activities and experiences that give meaning and significance to people's lives-irrespective of their religious affiliation. So far, spiritual aspects have been considered therapeutically mainly in the palliative context. According to current survey-based studies of pain patients, the inclusion of spiritual themes in therapy leads to an improvement in quality of life and pain tolerance and is moreover explicitly desired by those patients. A consistent expansion of multimodal treatment approaches in the sense of a biopsychosocial-spiritual concept has not yet been implemented. The following basic attitudes and behaviors are relevant for practical implementation: openness to spiritual themes and authenticity, taking a spiritual history, listening, standing firm, activation of values, use of motives from religion, mythology, and art. Professional competence generally involves all practitioners, but may also require qualified professionals for specialized assistance. The integration of authentic spiritual assistance into multimodal pain management should help to stabilize self-esteem and the experience of identity of the patients through resource activation and identification of burdensome spiritual beliefs. The detailed integration and investigation of the efficiency of spiritual interventions in multimodal pain therapy require further research.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"304-316"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466857","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}
Pub Date : 2024-10-01Epub Date: 2023-03-09DOI: 10.1007/s00482-023-00701-0
Petra Hampel, Anne Neumann
Background: The transition from acute to non-specific chronic low back pain (CLBP) is especially associated with psychological factors. However, working mechanisms of psychological factors have been little examined in non-specific CLBP, especially the mediator effect of pain self-efficacy.
Objective: Does pain self-efficacy mediate the long-term prediction of work-related factors by depressive symptoms?
Methods: Within the framework of an exploratory secondary analysis, simple mediation analyses were conducted to longitudinally predict prognosis of gainful employment, as well as subjective physical and mental work ability by depressive symptoms mediated by pain self-efficacy in 382 inpatients with non-specific CLBP.
Results: The findings suggest that depressive symptoms prior to rehabilitation predicted levels of all three work-related factors 24 months after rehabilitation, and pain self-efficacy 12 months after rehabilitation mediated this relationship.
Conclusion: To improve the success of work-related rehabilitation in the long-term, pain self-efficacy in particular, but also depressive symptoms should be targeted by treatments of non-specific CLBP.
{"title":"[Is the relationship between depressive symptoms and work-related factors mediated by pain self-efficacy in non-specific chronic low back pain?]","authors":"Petra Hampel, Anne Neumann","doi":"10.1007/s00482-023-00701-0","DOIUrl":"10.1007/s00482-023-00701-0","url":null,"abstract":"<p><strong>Background: </strong>The transition from acute to non-specific chronic low back pain (CLBP) is especially associated with psychological factors. However, working mechanisms of psychological factors have been little examined in non-specific CLBP, especially the mediator effect of pain self-efficacy.</p><p><strong>Objective: </strong>Does pain self-efficacy mediate the long-term prediction of work-related factors by depressive symptoms?</p><p><strong>Methods: </strong>Within the framework of an exploratory secondary analysis, simple mediation analyses were conducted to longitudinally predict prognosis of gainful employment, as well as subjective physical and mental work ability by depressive symptoms mediated by pain self-efficacy in 382 inpatients with non-specific CLBP.</p><p><strong>Results: </strong>The findings suggest that depressive symptoms prior to rehabilitation predicted levels of all three work-related factors 24 months after rehabilitation, and pain self-efficacy 12 months after rehabilitation mediated this relationship.</p><p><strong>Conclusion: </strong>To improve the success of work-related rehabilitation in the long-term, pain self-efficacy in particular, but also depressive symptoms should be targeted by treatments of non-specific CLBP.</p>","PeriodicalId":21572,"journal":{"name":"Schmerz","volume":" ","pages":"335-342"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9137764","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}