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[Treatment of trigeminal neuralgia: more evidence urgently needed]. [三叉神经痛的治疗:急需更多证据]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-14 DOI: 10.1007/s00482-024-00821-1
Ruth Ruscheweyh, Janne Gierthmühlen, Dennis M Hedderich, Gudrun Goßrau, Stefan Leis
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引用次数: 0
[Attitudes toward digital tools in pain medicine : Survey of German Pain Society health professional members and members of self-help groups]. [对疼痛医学数字工具的态度:对德国疼痛协会健康专业成员和自助团体成员的调查]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2023-03-20 DOI: 10.1007/s00482-023-00708-7
Janosch A Priebe, Philipp Stachwitz, Julia Hagen, Anne Boltres, Katharina K Haas, Philipp Schuster, Julia Wendlinger, Mike Papenhoff, Thomas Isenberg, Jorg F Debatin, Thomas R Toelle

Digital medicine has increasing influence on the German healthcare system. In times of social distancing during the ongoing coronavirus disease 2019 (COVID-19) pandemic, digital tools enable health professionals to maintain medical care. Furthermore, digital elements have potential to provide effective guideline-oriented treatment to a broad range of patients independently from location and time. This survey was used to assess the attitudes of members of the German Pain Society (health professionals) and of associated self-help groups (patients) towards digital medicine. It was sent out as an online survey to health professionals in September 2020 and to patients in February 2021. The survey referred especially to present usage, attitude and potential concerns regarding particular digital elements. Furthermore, technical affinity was assessed. In total, 250 health professionals and 154 patients participated in the survey. The results show that-although digital elements are already known-a substantial proportion of health professionals still lack broad transfer to regular treatment. The potential of digital tools seems to be recognized by both groups; interestingly, patients consider digital medicine as more useful than health professionals. Nevertheless, concerns about for example data security or digital competence remain in both groups. Taken together, our results indicate that disruptive changes, as the implementation of digital medicine in the healthcare system, have to be guided by intense education and channeled by political policies in order to successfully integrate digital elements into medicine on a long-term basis. This would be in favor for all involved parties and is demanded especially by patients.

数字医疗对德国医疗系统的影响越来越大。在 2019 年冠状病毒病(COVID-19)大流行期间,由于社会关系疏远,数字工具使医疗专业人员能够维持医疗服务。此外,数字元素还有可能不受时间和地点的限制,为广大患者提供以指南为导向的有效治疗。这项调查用于评估德国疼痛协会成员(医疗专业人员)和相关自助团体(患者)对数字医学的态度。该调查于 2020 年 9 月以在线调查的形式发送给医疗专业人员,并于 2021 年 2 月发送给患者。调查主要涉及目前的使用情况、对特定数字元素的态度和潜在担忧。此外,还对技术亲和力进行了评估。共有 250 名医疗专业人员和 154 名患者参与了调查。调查结果表明,尽管数字化元素已广为人知,但仍有相当一部分医疗专业人员缺乏对常规治疗的广泛了解。两个群体似乎都认识到了数字化工具的潜力;有趣的是,患者认为数字化医疗比医疗专业人员更有用。尽管如此,两类人群对数据安全或数字能力等方面的担忧依然存在。综上所述,我们的研究结果表明,像在医疗保健系统中实施数字医疗这样的颠覆性变革,必须通过强化教育和政治政策的引导,才能长期成功地将数字元素融入医疗中。这将有利于所有相关方,尤其是患者的需求。
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引用次数: 0
[Clinical study PEPCA : The effect of standardized preoperative patient education for patient-controlled regional analgesia on postoperative pain]. [临床研究 PEPCA:患者自控区域镇痛的标准化术前患者教育对术后疼痛的影响]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2023-02-07 DOI: 10.1007/s00482-023-00698-6
Tobias Bacher, Andre Ewers

Background: Patient-controlled analgesia (PCA) is a well-established form of postoperative pain management. One form of administration is patient-controlled regional analgesia (PCRA), where local anesthetics are administered via peripheral regional catheters; however, a prerequisite is that the patients are instructed on its use. A multitude of sources recommend that these instructions are given before surgery as preoperative training on pain management procedures has been shown to significantly reduce patients' postoperative pain and increase their well-being.

Objective: The aim was to assess the effect of guideline-assisted preoperative patient education for PCRA on postoperative pain in patients undergoing orthopedic surgery compared to unstructured postoperative standard instructions.

Material and methods: A controlled study with two randomized samples and a postinterventional survey was conducted. Overall, 73 patients with PCRA catheters for orthopedic surgery were enrolled in the study. The 37 participants in the interventional group (IG) received guideline-based structured instructions on PCRA use as well as a handout immediately before the surgical intervention. The 36 patients in the control group (CG) received postoperative instructions in the anesthesia recovery room. Pain was documented according to the numerical rating scale (NRS) at 2h (t1), 6h (t2), and 24h (t3) after surgery.

Results: There were no statistically significant differences in the average pain scores between the two groups; however, there were lower mean pain scores in the IG at t1 and t3.

Conclusion: A significant reduction of pain in the IG could not be shown. Further studies concerning this topic with larger samples and adapted points in time are recommended.

背景:患者自控镇痛(PCA)是一种行之有效的术后疼痛治疗方法。患者自控区域镇痛(PCRA)是其中一种给药方式,即通过外周区域导管给药局部麻醉剂;但前提条件是对患者进行使用指导。许多资料都建议在手术前进行这些指导,因为术前疼痛管理程序培训已被证明能显著减轻患者的术后疼痛并提高他们的幸福感:目的:与非结构化的术后标准指导相比,旨在评估针对 PCRA 的指导性术前患者教育对骨科手术患者术后疼痛的影响:进行了一项对照研究,包含两个随机样本和一项干预后调查。共有 73 名使用 PCRA 导管进行骨科手术的患者参与了研究。介入组(IG)的 37 名参与者在手术介入前立即接受了以指南为基础的 PCRA 使用结构化指导以及一份讲义。对照组(CG)的 36 名患者在麻醉恢复室接受术后指导。术后2小时(t1)、6小时(t2)和24小时(t3),根据数字评分量表(NRS)记录疼痛情况:结果:两组患者的平均疼痛评分在统计学上没有明显差异;但在 t1 和 t3 时,IG 组的平均疼痛评分较低:结论:IG 组的疼痛没有明显减轻。建议对这一主题进行更多的研究,并增加样本和调整时间点。
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引用次数: 0
[Additional experience with medicinal treatment of trigeminal nerve pain]. [药物治疗三叉神经痛的其他经验]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-14 DOI: 10.1007/s00482-024-00820-2
Wolfgang Liedtke
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引用次数: 0
[Prospective, multicenter study of the outcome of complex regional pain syndrome after 12 months]. [复杂性区域疼痛综合征 12 个月后疗效的前瞻性多中心研究]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-28 DOI: 10.1007/s00482-024-00837-7
H Hofbauer, A Brinkmann, E Maurer, B Weber, G Hänle, P Steffen

Background and objectives: Complex regional pain syndrome (CRPS) can lead to severe pain and limited functionality in the long term. Guidelines should help to optimize treatment procedures. It should be investigated which outcome is achieved after 1 year with guideline-based therapy.

Materials and methods: In a prospective multicenter study, 40 patients with newly diagnosed CRPS were examined to determine how their pain and functional limitations changed within 1 year. In addition, it was investigated whether the time of diagnosis and invasive measures influence these outcome parameters.

Results: All patients received physiotherapy and/or ergotherapy, treatment with glucocorticoids and/or bisphosphonates 29 (72.5%); various invasive measures were carried out in 13 (32.5%). After 1 year, both pain and functionality were significantly improved; two-thirds reported a tolerable average pain intensity. Severe functional impairment according to von Korff disability points was found after 1 year in 9 (22.5%), and a moderate or severe impairment according to medical evaluation in 6 (15%) and 3 (7.5%) patients, respectively. Earlier diagnosis and corresponding earlier start of treatment correlated with better outcome in terms of pain and functionality according to von Korff, but not according to medical evaluation. The influence of invasive procedures on the outcome parameters tended to be low.

Conclusion: Guideline-based treatment led to a good outcome in terms of pain and functionality in the majority of patients. Early diagnosis correlated with better outcome, so suspected cases should be referred quickly to a medical facility with appropriate expertise.

背景和目的:复杂性区域疼痛综合征(CRPS)可导致严重的疼痛,并在长期内限制患者的功能。指南应有助于优化治疗程序。材料和方法:在一项前瞻性多中心研究中,40 名新发区域性疼痛综合征患者接受了基于指南的治疗:在一项前瞻性多中心研究中,40 名新确诊的 CRPS 患者接受了检查,以确定他们的疼痛和功能限制在 1 年内的变化情况。此外,研究还探讨了诊断时间和侵入性措施是否会影响这些结果参数:所有患者均接受了物理治疗和/或工效治疗,29 例(72.5%)患者接受了糖皮质激素和/或双膦酸盐治疗;13 例(32.5%)患者接受了各种侵入性措施。一年后,患者的疼痛和功能均有明显改善;三分之二的患者表示平均疼痛强度可以忍受。根据 von Korff 残疾积分,1 年后发现有 9 名患者(22.5%)出现严重功能障碍,根据医学评估,分别有 6 名患者(15%)和 3 名患者(7.5%)出现中度或重度功能障碍。根据von Korff评分,早期诊断和相应的早期治疗与疼痛和功能方面更好的结果相关,但与医学评估结果无关。侵入性治疗对疗效参数的影响较小:结论:基于指南的治疗使大多数患者在疼痛和功能方面获得了良好的疗效。早期诊断与更好的疗效相关,因此应尽快将疑似病例转诊到具有相应专业知识的医疗机构。
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引用次数: 0
[Current knowledge of German physiotherapy trainees and students on pain and the influence of a teaching intervention]. [德国物理治疗受训人员和学生对疼痛的认知现状及教学干预措施的影响]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-28 DOI: 10.1007/s00482-024-00832-y
Ahura Bassimtabar, Martin Alfuth

Background: In order to properly inform patients about their pain and initiate targeted therapies, it is important for physiotherapists to learn about the latest scientific evidence on pain during their training.

Aim: This study aimed to assess the pain knowledge of German physiotherapy trainees and students. In addition, the influence of a teaching intervention (Pain Neuroscience Education, PNE) on their pain knowledge was investigated.

Methods: An online test was performed, which contained the German versions of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the Essential Knowledge of Pain Questionnaire (EKPQ). This test was completed by physiotherapy trainees and students (N = 279) in their final semester of vocational education or graduation under virtual supervision. After the test, a sub-cohort of physiotherapy trainees (n = 31) received a four-hour online teaching intervention (PNE), whereupon two retests took place.

Results: The mean rNPQ-D score (63.8%) was significantly higher than the mean EKPQ score (28.4%) (p < 0.001). There was a significant positive correlation between the scores of rNPQ-D and EKPQ (r = 0.365, p < 0.001). Undergraduate students from university (n = 142) achieved significantly higher scores in both questionnaires (p < 0.001) compared to trainees from vocational schools (n = 137). In the sub-cohort, the online teaching intervention significantly improved the scores of both questionnaires immediately (p < 0.001) and six weeks after intervention (p < 0.001).

Conclusion: The knowledge of German physiotherapy students about pain seems to be insufficient for an evidence-based treatment of pain patients. A PNE-based online learning program with the latest scientific evidence can significantly improve physiotherapy students' knowledge about pain.

背景:目的:本研究旨在评估德国物理治疗实习生和学生的疼痛知识。此外,还调查了教学干预(疼痛神经科学教育,PNE)对疼痛知识的影响:方法:进行了一项在线测试,其中包括德文版疼痛神经生理学问卷(rNPQ-D)和疼痛基本知识问卷(EKPQ)。该测试由职业教育或毕业班最后一学期的物理治疗学员和学生(279 人)在虚拟指导下完成。测试结束后,一部分物理治疗学员(31 人)接受了四小时的在线教学干预(PNE),之后进行了两次重测:结果:rNPQ-D 的平均得分(63.8%)明显高于 EKPQ 的平均得分(28.4%)(p 结论:德国物理治疗专业学生对物理治疗知识的了解程度远高于 EKPQ:德国物理治疗专业学生的疼痛知识似乎不足以对疼痛患者进行循证治疗。以 PNE 为基础的在线学习项目提供了最新的科学证据,可显著提高物理治疗专业学生的疼痛知识水平。
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引用次数: 0
[N-Check: nerve check to document chemotherapy-induced peripheral neuropathy (CIPN) in incurable cancer]. [N-Check:记录无法治愈的癌症患者化疗引起的周围神经病变(CIPN)的神经检查]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-23 DOI: 10.1007/s00482-024-00828-8
Annabell Syben, Sascha Weber, Iris Appelmann, Roman Rolke

Chemotherapy-induced polyneuropathy (CIPN) encompasses a spectrum of symptoms ranging from hypoesthesia with impaired gait, stance and fine motor skills to painful dysesthesia and allodynia and significantly impairs the quality of life of those affected. In the present pilot study, quantitative sensory testing (QST) was used to investigate CIPN as a common adverse effect of cytostatic drugs in patients with incurable cancer. The QST is a standardized examination procedure that is not yet routinely used in cancer patients. It is used to examine thermal and mechanical perception and pain thresholds to record the subjectively experienced pain phenotype. In the N‑Check pilot project, the QST was used before and after tumor-specific, potentially CIPN-inducing treatment and the data collected was compared in a pre-post analysis. In addition, the specific effects of CIPN on the health-related quality of life of patients treated primarily with a palliative intention were recorded using the Functional Assessment for Cancer Therapy-General (FACT-G) questionnaire. Overall, the patients showed significant heat hypoalgesia after chemotherapy as a sign of damage to small nerve fibers. In addition, there were signs of deterioration of the quality of life. The feasibility of QST in patients with incurable cancer and palliative, neurotoxic chemotherapy was demonstrated in this pilot study.

化疗诱发多发性神经病(CIPN)包括一系列症状,从步态、站姿和精细运动能力受损的感觉减退到疼痛性感觉障碍和感觉过敏,严重影响患者的生活质量。在本试验性研究中,采用了定量感觉测试(QST)来研究 CIPN 作为细胞抑制药物对无法治愈的癌症患者的一种常见不良反应。QST 是一种标准化检查程序,但尚未在癌症患者中常规使用。它用于检查热感、机械感和疼痛阈值,以记录主观感受到的疼痛表型。在 N-Check 试点项目中,QST 在肿瘤特异性、可能诱发 CIPN 的治疗前后使用,并在前后分析中对收集的数据进行比较。此外,还使用癌症治疗功能评估(FACT-G)问卷记录了 CIPN 对以姑息治疗为主的患者健康相关生活质量的具体影响。总体而言,患者在化疗后表现出明显的热低痛,这是小神经纤维受损的表现。此外,还有生活质量下降的迹象。这项试点研究证明了 QST 在无法治愈的癌症患者和姑息性神经毒性化疗患者中的可行性。
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引用次数: 0
[Avoidance-endurance fast screen : AEFS validation with one- and two-level response scaling in healthy subjects]. [回避-耐力快速筛查:在健康受试者中使用单级和双级反应标度对 AEFS 进行验证]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-20 DOI: 10.1007/s00482-024-00836-8
Sonja V Baumermann, Christina Titze, Monika I Hasenbring

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.

背景和目的:在德国,慢性疼痛影响着大量患者。因此,使用简单、快速、合理的筛查方法进行早期检测非常重要。回避-忍耐快速筛查目前有两种不同的版本:一种是询问轻度和重度疼痛时与疼痛相关的行为,另一种是评估与严重疼痛相关的总体行为。在本研究中,我们旨在检查这两种量表之间的一致性,并首次描述保护性心理特征(如复原力和自我同情)在这一模型中的作用:流行病学横断面研究(n = 278),研究对象为偶尔经历疼痛的健康人群(结果显示,两个量表的一致性适中,但在 "疼痛 "和 "疼痛 "之间存在差异:结果显示,两个版本的结果基本一致。对分组进行有效性检查后得出的结果具有可比性。单级版本在疼痛持续性方面得分较高,这导致了亚组从适应性反应到舒缓-耐受性反应,以及从恐惧-回避到痛苦-耐受性反应的变化。痛苦-忍耐亚组的自我同情特质值明显较低:根据本研究的结果,两个 AEFS 版本之间的一致性被认为很高。如果不对轻微疼痛和强烈疼痛进行比较,则更多人报告了忍耐行为。根据这些结果,使用单级版本可能会导致对疼痛持续行为的高估。因此,未来的研究应重新评估分界点。正如之前的研究中所报告的那样,保护性心理特征在舒缓-忍耐亚组中得分最高。
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引用次数: 0
[Influence of health care crises on the treatment of cancer pain: a presentation using the example of the COVID-19 pandemic from the provider's perspective]. [医疗危机对癌痛治疗的影响:以 COVID-19 大流行为例,从提供者的角度进行介绍]。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-05 DOI: 10.1007/s00482-024-00826-w
Frederik Dombrowski, Stefan Wirz, Hannes Hofbauer, Pascal Kowark, Joachim Erlenwein, Ulrike Stamer, Kristin Kieselbach

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.

背景:COVID-19 大流行导致疼痛医疗服务受到极大限制。癌症相关疼痛患者被认为是在护理方面处于弱势的群体。在为这一群体提供治疗的医疗机构中开展了一项问卷调查,以评估在这一危急情况下的局限性和解决方案:该在线调查由德国疼痛学会的 "肿瘤疼痛工作组 "采用德尔菲法编制而成,其中包括有关医疗机构结构、与大流行病相关的护理问题以及治疗患者所承受的负担等问题。该问卷通过德国疼痛学会和德国麻醉学与重症监护医学学会 "姑息医学工作组 "的邮件列表进行了多次分发:共对 175 份填写完整的问卷进行了分析。超过 75% 的参与者报告了与大流行病相关的人员短缺和疼痛医学机构关闭的情况,其中 32% 的机构暂时不收治选择性疼痛患者,13% 的机构不收治任何急诊患者。许多后勤问题阻碍了医疗服务,例如病人经常因大流行而取消就诊,或在传送处方时出现问题。分别有 79% 和 31% 的受访者报告了大流行前很少使用的电话或远程医疗等替代咨询方式,但也指出了不足之处。此外,52.1% 的受访者抱怨大流行造成了严重的心理压力,26.8% 的受访者抱怨有中等程度的心理压力,74.1% 的受访者将工作条件评价为中等至严重困难。86%的受访者仍可通过改变形式接受医疗培训:COVID-19大流行揭示了癌症相关疼痛患者护理中的诸多不足,以及医疗服务提供者的负担。新概念的开发有助于确保在未来的危机情况下提供更好的护理。
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引用次数: 0
Wir gestalten Zukunft : Abstracts des Deutschen Schmerzkongresses 2024: 16.–19. Oktober 2024 im CC Rosengarten, Mannheim. 我们塑造未来:2024 年德国疼痛大会摘要:2024 年 10 月 16-19 日,曼海姆罗森加滕 CC 会议中心。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 DOI: 10.1007/s00482-024-00827-9
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引用次数: 0
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