Schmerzchronifizierung, Geschlecht und Rehabilitationserfolg bei chronischem Rückenschmerz: Eine Pilotstudie

[The Mainz Pain Staging System is also suitable for grading chronic pain in inpatient geriatric patients]

INTRODUCTION

The Mainz Pain Staging System (MPSS), which has been validated primarily in middle-aged and chronic low back pain patients, is designed to predict prognosis and control the use of resources at baseline. In multi-morbid and functionally impaired patients (geriatric patients) with multiple causes of pain, it is unclear whether this instrument can be implemented at all and whether it permits statements to be made on the severity of pain chronification.

MATERIALS AND METHODS

Therefore, 173 consecutive patients with pain were classified in the second week of inpatient geriatric treatment according to the MPSS. For validation, the questions from the "Pain interview for geriatric patients" (SgP) were used. In addition, the MPSS was compared with the personal history of the duration of the main pain.

RESULTS

With the exception of the questions on medication intake, the items in the MPSS could be collected predominantly by self-assessment. Even with current analgesic therapy, MPSS has significant correlations with sensory, affective, and emotional dimensions of pain from the SgP. The data on duration correlated with only one category of MPSS (spatial aspects of pain).

CONCLUSION

MPSS can be used in multi-morbid and functionally impaired elderly patients undergoing inpatient treatment. Chronification features are more pronounced at higher stages than at lower levels. Only one category of the MPSS cannot be collected by self-assessment. The possibilities of prognosis estimation and resource control using the MPSS should be further investigated for these patients.

Long-Term Outcomes of a Multimodal Day-Clinic Treatment for Chronic Pain under the Conditions of Routine Care

Chronic pain has high prevalence rates and is one of the top causes of years lived with disability. The aim of the present study was to evaluate the long-term effects of a multimodal day-clinic treatment for chronic pain. The sample included 183 chronic pain patients (114 females and 69 males; 53.3 ± 9.8 years) who participated in a four-week multimodal day-clinic treatment for chronic pain. The patients' average current pain intensity (NRS), sensory and affective pain (Pain Perception Scale), and depression and anxiety (HADS) were assessed at pre- and posttreatment, as well as at three follow-ups (one month, six months, and twelve months after completion of the treatment). Multilevel models for discontinuous change were performed to evaluate the change of the outcome variables. Improvements from pretreatment to posttreatment and from pretreatment to all follow-ups emerged for pain intensity (NRS; 0.54 ≤ d ≤ 0.74), affective pain (Pain Perception Scale; 0.24 ≤ d ≤ 0.47), depression (HADS; 0.38 ≤ d ≤ 0.53), and anxiety (HADS; 0.26 ≤ d ≤ 0.43) (all p < 0.05). Sensory pain as assessed with the Pain Perception Scale did not show any significant change. Patients suffering from chronic pain benefited from the multimodal pain treatment up to twelve months after completion of the treatment.

[Psychosocial factors in chronic low back pain in orthopaedic inpatient rehabilitation. An analysis using the axes of the Mainz Pain Staging System]

BACKGROUND

The aim of this study was to investigate the criterion validity of the Mainz Pain Staging System (MPSS), considering the four axes of the MPSS separately.

METHODS AND DESIGN

Psychological and pain-related impairments were analysed depending on the stage of axis (I, II, III) for each single axis of the MPSS in a consecutive sample of 280 patients with chronic low back pain in orthopaedic inpatient rehabilitation. In addition, the distribution of frequency of clinically significant symptoms in depression, anxiety and somatisation were examined depending on the stage of axis.

RESULTS

For all axes, an increasing stage was associated with greater psychological and pain-related impairments. Particularly patients assigned to stage III on axis 1 (temporal aspects) and 2 (spatial aspects) and patients assigned to stage II on axis 3 (drug intake) and 4 (utilisation of the health care system) showed enhanced psychosocial impairments and more frequently had clinically relevant symptoms in psychological variables.

CONCLUSION

Findings confirm the criterion validity of the MPSS for chronic low back pain. In addition, results support the significance of psychosocial factors for the further development of chronicity.