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1.
Background
The in part promising, in part discrepant efficacy of psychological treatment of chronic musculoskeletal pain indicates a demand for interdisciplinary assessment and corresponding treatment structures with differentiated degrees of psychological and syndrome-specific specialization within a multimodal orthopedic context. Acceptance of pain and psychological flexibility are strongly related to physical impairments caused by pain.Objective
Goals are improved outcomes of medical and physical treatment measures as well as their flexible implementation in daily life through a differentially indicated psychological pain therapy focusing on pain acceptance and mindfulness.Methods
This study employed the “active not doing and generating inner silence” exercise from mindful-based pain therapy (“Achtsamkeitsbasierte Schmerztherapie”, ABST).Results
Pure observation of a problem without an attempt to solve it is unusual and strange. Prerequisites for such exercises are willingness to engage as well as courage and openness.Conclusion
A differentiated indication for clinical psychological treatment or psychotherapy of pain—a highly specialized form of psychological pain therapy—should be based on the diagnostic criterium of pain acceptance.2.
Background
Increased pain sensitivity is characteristic for patients with chronic pain disorder with somatic and psychological factors (F45.41). Persistent stress can induce, sustain, and intensify pain sensitivity, thereby modulating pain perception. In this context, it would be favorable to investigate which psychosocial stressors are empirically linked to pain sensitivity.Objectives
The aim of this study was to examine the relationship between psychosocial stressors and pain sensitivity in a naturalistic sample of patients with chronic pain disorder with somatic and psychological factors (F45.41).Materials and methods
We assessed 166 patients with chronic pain disorder with somatic and psychological factors (F45.41) at entry into an inpatient pain clinic. Pain sensitivity was measured with a pain provocation test (Algopeg) at the middle finger and earlobe. Stressors assessed were exposure to war experiences, adverse childhood experiences, illness-related inability to work, relationship problems, and potentially life-threatening accidents. Correlation analyses and structural equation modeling were used to examine which stressors showed the strongest prediction of pain sensitivity.Results
Patients exhibited generally heightened pain sensitivity. Both exposure to war and illness-related inability to work showed significant bivariate correlations with pain sensitivity. In addition to age, they also predicted a further increase in pain sensitivity in the structural equation model.Conclusions
Bearing in mind the limitations of this cross-sectional study, these findings may contribute to a better understanding of the link between psychosocial stressors and pain sensitivity.3.
Background
Owing to a rise of psychosomatic comorbidities, the treatment of psychological disorders, which may negatively impact prognosis and therapy, is increasingly becoming a focus of attention for pain outpatient clinics.Aim
This study investigates and discusses the advantages of liaison psychiatric care in a university pain clinic.Methods
In this retrospective study, we investigated all patients who presented to an anaesthesiologically led pain clinic between January and June 2014. The psychiatric history was taken by the liaison psychiatrist of the pain clinic.Results
In the period investigated, 485 patients were treated as outpatients. A psychiatric diagnosis was present 351 patients (72.4%). The distribution of the diagnoses was comparable with that of a consultation service. Adaptation and affective disorders dominated. The patients were preferentially treated with new generation antidepressants.Conclusion
The constant presence of a liaison psychiatrist allows for timely, specialised care of pain patients in terms of a multimodal therapeutic approach.4.
Background
Parental reactions to their child’s pain can comprise cognitive-affective and behavioral responses. Dysfunctional responses like parental catastrophizing may lead to an aggravation of the child’s pain.Objectives
Aims of the online-based study were (1) to psychometrically evaluate existing questionnaires into cognitive-affective (Pain Catastrophizing Scale for Parents; PCS-P) and behavioral responses (Inventar zum schmerzbezogenen Elternverhalten; ISEV-E) within a sample of 105 healthy parents, and (2) to compare their responses to existing (inter)national clinical samples and to the reactions of 80 parents with self-reported chronic pain from the general population.Methods
The assessment of parental pain-related reactions was online-based.Results
While the factor structure of the ISEV-E could not be replicated, the three factors of the PCS-P could be replicated. Parental catastrophizing of the healthy parents was lower compared to clinical samples. Healthy parents did not differ from parents with chronic pain from the general population.Conclusion
The results offer a basis to grade parental catastrophizing, so that risk-groups can be identified.5.
Background
Children and adolescents with severe hemophilia commonly suffer from acute and chronic pain as a consequence of hemophilia-related bleeding. Intervention-related pain also plays a major role. Despite its high prevalence in this patient group, hemophilia-related pain is not always adequately addressed and sufficiently treated.Objectives
This paper discusses how to improve pain management for children and adolescents (0–18 years) with hemophilia and which specific features in this population should influence decisions in pain management.Materials and methods
An expert panel discussed challenges in pain treatment in children and adolescents with hemophilia. Recommendations are based on evidence and clinical experience.Result
Pain management in children with hemophilia needs improvement. Children with hemophilia are at risk of developing chronic pain and of suffering traumatization due to insufficient pain management. Pain therapy can be challenging in these children as both their age and the underlying disease limit the options in particular in pain medication. The expert panel developed recommendations to improve pain management in children with hemophilia.6.
Background
Interdisciplinary pain therapy is nowadays the state of the art for the treatment of chronic unspecific back pain. The aim of this article is to present the retrospective analysis of the data from a 1-week intensive outpatient multimodal interdisciplinary pain therapy group program for treatment of patients with chronic unspecific back pain.Design and methods
The questionnaire-based data from patients who attended the program were evaluated before as well as 3 and 12 months after finishing the program. The patients were questioned regarding parameters, such as pain severity, quality of life, pain-related disability, depression and pain acceptance.Results
On average a significant improvement of all parameters after 3 and 12 months could be demonstrated (excluding the domains “social” and “environment” in the context of quality of life).Discussion
Interestingly, the results showed a significant improvement of almost all evaluated parameters even after a period of 12 months (unfortunately only data for 41 patients were available). In our opinion this improvement is due to the special constellation of the presented program, which with 1 week is relatively short but very intensive with 34?h of treatment. In addition, the program is integrated into a long-term multimodal outpatient treatment, a concept in which the multimodal treatment is individually continued after the 1?week program. On the other hand, the results especially after 12 months have to be interpreted particularly in this context.7.
K. Limbrecht-Ecklundt P. Werner H. C. Traue A. Al-Hamadi S. Walter 《Schmerz (Berlin, Germany)》2016,30(3):248-256
Background
The monitoring of facial expressions to assess pain intensity provides a way to determine the need for pain medication in patients who are not able to do so verbally.Objectives
In this study two methods for facial expression analysis – Facial Action Coding System (FACS) and electromyography (EMG) of the zygomaticus muscle and corrugator supercilii – were compared to verify the possibility of using EMG for pain monitoring.Material and methods
Eighty-seven subjects received painful heat stimuli via a thermode on the right forearm in two identical experimental sequences – with and without EMG recording.Results
With FACS, pain threshold and pain tolerance could be distinguished reliably. Multiple regression analyses indicated that some facial expressions had a predictive value. Correlations between FACS and pain intensity and EMG and pain intensity were high, indicating a closer relationship for EMG and increasing pain intensity. For EMG and FACS, a low correlation was observed, whereas EMG correlates much better with pain intensity.Conclusions
Results show that the facial expression analysis based on FACS represents a credible method to detect pain. Because of the expenditure of time and personal costs, FACS cannot be used properly until automatic systems work accurately. The use of EMG seems to be helpful in the meantime to enable continuous pain monitoring for patients with acute post-operative pain.8.
Background
The subjective state of health with respect to pain and psyche was surveyed utilizing validated pain questionnaires in patients undergoing special pain therapy and represents the basis for targeted treatment measures.Objective
The purpose of this study was to investigate the possible distortion of answers due to social desirability of responses in chronic pain patients.Material and methods
During two survey periods assessing patient satisfaction using both anonymized and personalized questionnaires, the effects arising from socially desirable response patterns were analyzed. The sample consisted of chronic pain patients being treated in an inpatient therapy setting.Results
In both periods of observation no significant impact on the response behavior of chronic pain patients was found in personalized or anonymized questionnaires.Conclusion
The results of the study suggest that the responses of chronic pain patients with respect to their subjective state of health are not influenced by social desirability. Thus, scoring systems such as the German pain questionnaire will not be influenced by social desirability in chronic pain patients and can therefore be used as a part of diagnostics and therapy planning.9.
Background
Subcutaneous peripheral nerve field stimulation (sPNFS) is an established procedure for the treatment of chronic localized neuropathic pain of peripheral origin. The treatment of nummular headache primarily focuses on conservative methods with limited prospects of success. The role of sPNFS in the treatment of nummular headache has not been investigated as yet.Question
Is the sPNFS an option in the management of nummular headache?Materials and methods
In addition to a summary of established methods in the treatment of nummular headache, sPNFS as a possible form of therapy is discussed.Results
A positive effect of sPNFS in terms of the treatment of nummular headache is shown.Discussion
sPNFS stimulates free subcutaneous nerves and transmits a pleasant form of paraesthesia in the area of pain. If regular conservative therapy has already been exhausted, then sPNFS might be an effective new option in the treatment of nummular headache. sPNFS is a minimally invasive and low-risk procedure. However, the high treatment cost and restrictions regarding fitness to undergo MRI are points of criticism. Further studies are needed to define its potential and role in the treatment of nummular headache.10.
Background
Pain, restriction of mobility and cognitive impairment are often present in old age and intensify each other.Objectives
Is there a relationship between mobility, pain, cognitive capacity, diagnoses and number of prescribed medication for residents of nursing homes?Methods
Subgroup analysis of the baseline data from an intervention study for optimization of the medication safety of 120 nursing home residents.Results
Pain was presumed in 77.8% of the residents. Persons with cognitive impairment were more frequently affected. The results of the observational and self-reported pain assessment in cognitively impaired patients did not agree for two-thirds of the cases. A correlation between prevalence of pain, pain intensity and mobility could only be shown for persons without cognitive impairment. Half of the persons were unable to walk; 80% of the residents with analgesics as a permanent medication were more restricted in their mobility.Conclusions
Cognitive impairment is associated with pain and reduced mobility, whereby self-rated pain did not concur with the observational pain assessment for two-thirds of the residents with cognitive impairment. This illustrates the difficulty of observational pain assessment.11.
Background
The use of a scientifically developed App for pain management in the home care setting is not yet established in Germany. The documentation of pain-specific data by the patients and the transfer into a web portal to be examined by the attending physician can help close the existing communication gap in pain management between consultations.Objectives
The aim of the study was to develop a mobile health (mHealth) solution for optimizing pain management in the home care setting. The research questions focus on design and technical issues concerning layout and navigation of the painApp as well as user-relevant questions concerning pain management, such as pain at rest and pain during movement, taking pain medication and patient satisfaction with their pain situation.Materials and methods
Within a 12-month period, the user-centered development and practice-based testing of the application painApp involved patients aged?≥?65 years. Within a formative evaluation, a total of four data collections and a final survey took place. During the same period, a web portal was developed and tested the documentation of the patient pain-specific data from the painApp with the participation of general practitioners.Results and conclusions
The development of the painApp as a prototype was realized in the study with high acceptability by the patients. The painApp is able to establish digital communication with the general practitioner without any technical problems and allows the physician access to patient data in real time.12.
Background
Chronic pain is characterized by a complex interaction of somatic, mental and social factors. Assessing these factors in patients with chronic pain is vital during the diagnostic work-up and when making a structured treatment plan. Interdisciplinary pain assessment (ISA) is the most promising method to deal with these challenges. This article presents our experience in performing pain assessments in the hospital setting and also illustrates the characteristic features of chronic pain patients undergoing such assessments.Methods
This study reviews and evaluates patient data from 2704 ISAs performed at the Interdisciplinary Pain Centre of the Zentralklinik Bad Berka, Germany, between 2008 and 2015.Results
The majority of our ISA patients are severely handicapped and show distinct signs of chronic disease. A large proportion of patients is either unable to work or receiving benefits (invalidity pension or retirement pension). In addition, patients reported long disease durations and high emotional distress. Treatment recommendations were based on the patients’ individual clinical presentations and examination results. More than half of the patients required multimodal pain management, while adjustments or therapeutic withdrawal of pain medications, in particular of opioids, were indicated in many patients.Discussion
Our study shows that ISA enables fast, high-quality diagnostic assessments of chronic pain while taking the biopsychosocial model of pain in particular into account. In addition, ISA is not biased with regard to outcome results and recommends the further treatment that appears best for the individual patient. ISA leads not only to inpatient treatment, but also to treatment in other therapeutic settings and, as such, is not merely a door-opener to multimodal pain therapy.14.
Background
As there is currently no gold standard for the diagnosis of SIJ dysfunction, a broad variety of tests exist to clinically identify pelvic girdle pain caused by reversible SIJ dysfunction. Some of the pain provocation tests have already been evaluated. However, the tests used by the majority of German physicians competent in manual medicine (MM) have not yet been evaluated. Therefore, such an evaluation is necessary.Objective
The aims of the study were to evaluate the reliability of functional and pain provocation tests used in SIJ diagnostics, and to propose a useful set of reliable tests.Methods
Two raters investigated 161 subjects (81 symptomatic with low back pain, 80 asymptomatic controls) in a blinded setting, each with a set of three functional and six pain provocation tests. Three of the pain provocation tests had already been evaluated and these were used for comparison with the non-evaluated tests.Results
The Cohen’s kappa coefficients of the newly evaluated tests were better (κ?=?0.76–1.00) than those of the previously evaluated tests (κ?=?0.65–0.89). The functional tests had a lower κ?coefficient and an overly wide confidence interval (CI), and were thus evaluated as being not reliable and only suitable as screening tests.Conclusions
The pain provocation tests, which use palpable irritation deep in the gluteal muscles with provocation in two planes, are at least as reliable as the already evaluated tests. We recommend adding SIJ irritation point diagnostics to the set of “3 out of 5 positive pain provocation tests” for safe diagnosis of SIJ dysfunction.15.
Background
There is neither a “gold standard” nor commonly approved therapy goals in postoperative pain therapy. In a multi-center study, more than 80% of all patients treated stated that they suffered from postoperative pain. Moreover, patients evaluated the pain therapy as significantly worse than other medical or nursing practices. Therefore, there is a need for optimization in therapy for acute pain.Objectives
The goal of our project was to figure out if the introduction of a “pain treatment standard” would increase the satisfaction of patients, physicians, and nurses, and reduce the costs of pain-related medicine.Materials and methods
Overall, 2769 patients and 285 providers (202 nurses and 83 physicians) were polled. The medication costs in ten areas of the ward were evaluated and compared. The providers were offered a training course on the “pain standard” and it was officially introduced onto the wards. After some time, the satisfaction of patients and providers and the use of medicine were recorded again.Results and Discussion
The maximum pain values declared by the patients significantly decreased after the introduction of the “pain standard.” The satisfaction with pain therapy significantly increased for the patients and for the providers. The reported minimum pain values of the patients did not change significantly. The costs of pain medicine slightly increased. In general, there was a positive effect of introducing a “pain standard” for patients and providers.17.
Background
Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes.Methods
The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords “psychosocial screening”, “low back pain”, “sciatica” and “prognosis”, “athletes”. We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months.Results
We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF).Conclusion
Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.18.
Background and objectives
The synthetic opioid tilidine is often used in chronic pain treatment. However, the activation via metabolism in patients with concomitant medication and reduced liver or kidney function is not thoroughly investigated. We therefore studied pain treatment efficacy, health-related quality of live and the metabolism of tilidine in patients with chronic pain.Methods and materials
In all, 48 patients, who were on a stable dose of oral prolonged release tilidine for at least 7 days, were included in this observational multicenter study. Liver and kidney function were assessed in routine blood samples, concentrations of tilidine, nortilidine and bisnortilidine were determined using a validated LC/MS/MS method. Comedication was registered and patients experience with regard to quality of life, pain, gastrointestinal symptoms and adverse events was assessed in standardised questionnaires.Results
On average a daily dose of 180?mg tilidine was taken. Dose normalized plasma concentrations of the active metabolite nortilidine ranged between 1.6?ng/ml and 76.5?ng/ml (mean 29.2 ± 25.1?ng/ml). Ratios between tilidine and nortilidine were on average 0.28 (median = 0.13, standard deviation = 0.67). Patients were on 1 to 14 different concomitant medications. About 66% of the patients had sufficient pain treatment. Almost no opioid-induced constipation was observed. Only few patients had decreased kidney or liver function which did not result in elevated nortilidine concentrations.Conclusion
Pain treatment using tilidine resulted in variable nortilidine concentrations which are obviously not strongly influenced by comedication or reduced liver or kidney function. Only a few side effects were observed with almost no opioid-induced constipation.19.
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