Schmerz最新文献

The spontaneous reporting system for cases of suspected side effects is a central instrument for detecting possible side effects after a pharmaceutical preparation has received marketing authorization. It provides important information (signals) on the occurrence of rare, previously unknown side effects, on increases in the frequency of known side effects that may also be due to quality defects, or on changes in the type or severity of known side effects. In recent decades, this system has made a significant contribution to the identification of drug-related risks that only arise upon widespread use following approval and to the introduction of appropriate measures to minimize risk.

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.

In addition to the usual evaluation approach (usually a clinical randomized trial in the sense of the question: does an intervention work), complex interventions require further systematic investigations to prove their effectiveness. The role of the context in which the intervention is delivered is essential here, as is consideration of the question of why an intervention works (or does not work). Detailed recommendations exist for the planning and implementation of effectiveness studies on complex interventions, to which interdisciplinary multimodal pain therapy undoubtedly belongs. In an effectiveness model, concrete, verifiable assumptions are formulated as to how an intervention produces changes that are reflected in the endpoint. This article provides a brief introduction to methodological approaches to effectiveness research on complex interventions and uses the PAIN 2.0 project (01NVF20023) to describe in concrete terms what an effectiveness model for interdisciplinary multimodal pain therapy for the prevention of chronic pain in an outpatient setting might look like.

Complex regional pain syndrome (CRPS) is a severe pain disorder with an unclear pathophysiology. Biomarkers offer opportunities to enhance diagnosis, stratification, prognosis, and monitoring. Serum markers such as cytokines and microRNAs show potential but require further research. Local skin markers, particularly pro-inflammatory cytokines, are elevated in the acute stage and correlate with disease activity. Imaging techniques such as skeletal scintigraphy and functional magnetic resonance imaging provide valuable insights into structural and functional changes, despite inconsistent results to date. Psychosocial factors, including pain intensity and psychological comorbidities, are important prognostic indicators. Future research should focus on specific biomarkers to develop mechanism-based treatments. A multidisciplinary approach remains crucial for effective treatment.

Background: The importance of opioids in the treatment of non-cancer pain is under debate. No current data are available from Germany on the prevalence of opioid treatment for non-cancer pain.

Aim of the study: Data on the prevalence of short- and long-term opioid prescriptions for patients without cancer, prescribed agents, co-medication, specialty of prescribing physicians, demographic and clinical characteristics of patients.

Materials and methods: Retrospective analysis of billing data of adult BARMER-insured persons without evidence of cancer (N = 6,771,075) in 2021 and for patients initiating opioid therapy in 2019 (n = 142,598).

Results: In total, 5.7% of the insured persons without a cancer diagnosis received at least one prescription for an opioid in 2021, while 1.9% received long-term therapy. Tilidine and tramadol were the most frequently prescribed opioids in short- and long-term therapy. Women received opioids more frequently than men. The frequency of prescriptions significantly increased with age. In 2021, 22.5% of insured persons with long-term opioid therapy received a co-medication with pregabalin and/or gabapentin, 37.5% with an antidepressant and 58.1% with metamizole and/or NSAIDs. A total of 59.5% of first prescriptions were issued by general practitioners. In the first year of therapy, an average of 2.1 practices were involved in prescribing analgetics for people on long-term opioid therapy and 13 different chronic diseases were documented.

Discussion: Opioid therapy for non-cancer-related pain is predominantly carried out by general practitioners in older and multi-morbid patients. The indication for or against opioid therapy requires shared decision-making with patients and, if necessary, their relatives, as well as a review of possible drug interactions.

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.

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.

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 (χ²_{ECQ_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.

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.