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Motive Satisfaction in Chronic Pain Patients: Does It Improve in Multidisciplinary Inpatient Treatment and, if so, Does It Matter? J Clin Psychol Med Settings 2021; 28:331-343. [PMID: 32338351 PMCID: PMC8192351 DOI: 10.1007/s10880-020-09718-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
According to consistency theory, insufficient motive satisfaction (motivational incongruence) is associated with psychological distress and mental disorders. High levels of distress and comorbid psychological disorders are common in patients with chronic pain. The aim of the present study was to investigate the role of motivational incongruence in chronic pain patients and the association of incongruence change with symptom improvement. Inpatients with chronic pain in multimodal interdisciplinary treatment (n = 177) completed questionnaires measuring motivational incongruence, psychological distress, pain intensity and pain interference at the beginning and end of a multimodal interdisciplinary inpatient treatment program at a tertiary psychosomatic university clinic. Results demonstrated that pain and motivational incongruence were significantly reduced at post-treatment, and reductions in incongruence were associated with reductions in psychological distress. In particular, better satisfaction of approach motives mediated the association between reduction of pain interference and psychological distress at post-treatment. Findings suggest that a reduction of motivational incongruence may be part of successful treatment of chronic pain.
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[Characteristic values and test statistical goodness of the Veterans RAND 12-Item Health Survey (VR-12) in patients with chronic pain : An evaluation based on the KEDOQ pain dataset]. Schmerz 2021; 36:109-120. [PMID: 34279750 PMCID: PMC8956556 DOI: 10.1007/s00482-021-00570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/13/2021] [Accepted: 06/08/2021] [Indexed: 11/01/2022]
Abstract
The Veterans RAND 12-Item Health Survey (VR-12) was added to the German Pain Questionnaire (DSF) as a self-report measure of health-related quality of life in 2016, replacing the previously used SF-12, which required a license. Both measures have 12 items and include a physical component summary (PCS) and a mental component summary (MCS). Evaluations with a larger sample on characteristic values and on the test-statistical goodness of the VR-12 in patients with chronic pain are so far missing. Data on the VR-12 and other procedures of the DSF were evaluated from 11,644 patients from 31 centers participating in KEDOQ pain. The patients filled out the DSF before starting a pain therapy treatment. Change sensitivity was determined for 565 patients for whom the VR-12 was available from a follow-up questionnaire of the DSF several months after the initial survey.The reliability (Cronbach's alpha) of the PCS was rtt = 0.78 and for the MCS rtt = 0.84. The MCS had significant relationships with the depression, anxiety and stress scales (r = -0.51 to r = -0.72), and the PCS correlated more highly with areas of pain-related impairment (r = -0.48 to r = -0.52). Patients with higher pain chronicity, those with higher pain severity, and those with evidence of high psychological distress described significantly lower health-related quality of life in PCS and MCS. The effect size (ES) of change in terms of improvement in health-related quality of life was ES = 0.33 in the MCS and ES = 0.51 in the PCS.The results are in agreement with the findings of the SF-36 and SF-12 in patient collectives with chronic pain. In summary, they show that the VR-12 is an adequate substitute for the SF-12 in the German pain questionnaire.
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Evers C, Jordan S, Maurer B, Becker MO, Mihai C, Dobrota R, Hoederath P, Distler O. Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis. Arthritis Res Ther 2021; 23:34. [PMID: 33468227 PMCID: PMC7816465 DOI: 10.1186/s13075-021-02421-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pain is a frequent, yet inadequately explored challenge in patients with systemic sclerosis (SSc). This study aimed to conduct an extensive pain assessment, examining pain chronification and its association with disease manifestations. Methods Consecutive SSc patients attending their annual assessment were included. SSc-specific features were addressed as defined by the European Scleroderma Trials and Research (EUSTAR) guidelines. Pain analysis included intensity, localization, treatment, chronification grade according to the Mainz Pain Staging System (MPSS), general well-being using the Marburg questionnaire on habitual health findings (MFHW) and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Results One hundred forty-seven SSc patients completed a pain questionnaire, and 118/147 patients reporting pain were included in the analysis. Median pain intensity was 4/10 on a numeric rating scale (NRS). The most frequent major pain localizations were hand and lower back. Low back pain as the main pain manifestation was significantly more frequent in patients with very early SSc (p = 0.01); those patients also showed worse HADS and MFHW scores. Regarding pain chronification, 34.8% were in stage I according to the MPSS, 45.2% in stage II and 20.0% in stage III. There was no significant correlation between chronification grade and disease severity, but advanced chronification was significantly more frequent in patients with low back pain (p = 0.024). It was also significantly associated with pathological HADS scores (p < 0.0001) and linked with decreased well-being and higher use of analgesics. Conclusions Our study implies that also non-disease-specific symptoms such as low back pain need to be considered in SSc patients, especially in early disease. Since low back pain seems to be associated with higher grades of pain chronification and psychological problems, our study underlines the importance of preventing pain chronification in order to enhance the quality of life.
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Affiliation(s)
- Caroline Evers
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Mike Oliver Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Petra Hoederath
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland.,Centre of Neurosurgery Hirslanden Ostschweiz, Paintherapy Stephanshorn, Brauerstrasse 95a, 9016, St. Gallen, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland.
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Hüppe M, Kükenshöner S, Böhme K, Bosse F, Casser HR, Kohlmann T, Lindena G, Nagel B, Pfingsten M, Petzke F. [Pain therapy care in Germany-Do patients receiving day care differ from those receiving outpatient or inpatient care at the start of treatment? : A further evaluation based on the KEDOQ-pain data set]. Schmerz 2020; 34:421-430. [PMID: 32451747 DOI: 10.1007/s00482-020-00480-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The direct comparison of day care pain patients with patients from other treatment sectors with respect to sociodemographic, pain-related and psychological characteristics has not yet been the subject of systematic analyses. The project core documentation and quality assurance in pain therapy (KEDOQ-pain) of the German Pain Society (Deutsche Schmerzgesellschaft e.V.) makes this comparison possible. This second analysis of the available KEDOQ data was intended to show how patients receiving day care treatment can be characterized using the core data set and whether and to what extent they differ from patients receiving outpatient or inpatient treatment. This is a continuation of the first publication, which showed remarkably small differences between outpatients and inpatients but did not include day care patients.The KEDOQ-pain data from 25 centers with a total of 8953 patients were evaluated. Patients had completed the German pain questionnaire (DSF) between January 2012 and March 2017 and received day care (n = 1264), outpatient (n = 4082) or inpatient (n = 3607) pain therapy treatment. Sociodemographic, pain-related and psychometric data of the DSF reported by patients were evaluated as well as physician information on the pain chronification stage and pain localization. The evaluation was descriptive and compared groups using univariate and multivariate procedures.Day care treated patients were significantly younger, had a higher level of education, were more frequently employed, reported higher impairment values and showed a higher severity index according to von Korff than inpatients and outpatients treated for pain. In addition, they described a shorter pain duration as well as worse habitual well-being (Marburg questionnaire on habitual well-being, MFHW). These predictors explained roughly half of the variance in the prediction of the day care treatment setting. The comparison of outpatients and inpatients showed significant group differences for some variables; however, the effects were very small.The evaluations suggest that pain therapy day care facilities treat a special group of pain patients that significantly differ from patients in other treatment sectors. Cautious conclusions are drawn regarding the systematic allocation of patients to care appropriate to their treatment needs.
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Affiliation(s)
- M Hüppe
- Klinik für Anästhesiologie und Intensivmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - S Kükenshöner
- Klinik für Anästhesiologie und Intensivmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - K Böhme
- Schmerzzentrum Kassel, Kassel, Deutschland
| | - F Bosse
- RKH Kassel, Kassel, Deutschland
| | - H-R Casser
- DRK Schmerz-Zentrum Mainz, Mainz, Deutschland
| | - T Kohlmann
- Institut für Community Medicine, Universität Greifswald, Greifswald, Deutschland
| | - G Lindena
- CLARA Klinische und Versorgungsforschung Kleinmachnow, Kleinmachnow, Deutschland
| | - B Nagel
- DRK Schmerz-Zentrum Mainz, Mainz, Deutschland
| | - M Pfingsten
- Schmerzklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - F Petzke
- Schmerzklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Schuler M, Schwarzmann G. [The Mainz Pain Staging System is also suitable for grading chronic pain in inpatient geriatric patients]. Schmerz 2020; 34:332-342. [PMID: 32157443 DOI: 10.1007/s00482-020-00455-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Matthias Schuler
- Klinik für Geriatrie, Alterstraumatologie und Palliativmedizin, Speyerer Str. 91-93, 68163, Mannheim, Deutschland.
| | - Gerhard Schwarzmann
- Innere Medizin und Intensivmedizin, Theodor-Storm-Kai 7, 60590, Frankfurt, Deutschland
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Köpnick A, Hampel P. [Validity of the Mainz Pain Staging System for chronic low back pain : A cross-sectional analysis of inpatient multidisciplinary rehabilitation]. Schmerz 2020; 34:343-349. [PMID: 32322971 DOI: 10.1007/s00482-020-00466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychological factors have an influence on the manifestation as well as on the maintenance of chronic low back pain (CLBP) and are increasingly considered in research. OBJECTIVES The present study investigated the validity and clinical relevance of the Mainz Pain Staging System (MPSS) to replicate previous study results in the setting of inpatient multidisciplinary orthopedic rehabilitation (MOR). METHODS In this multicenter study, psychological and pain-related parameters were investigated among 1012 patients with nonspecific CLBP (ICD-10: M51/53/54) at the beginning of an inpatient MOR stratified according to the stage of pain in the MPSS (I-III). In addition, frequency distributions of scores in the clinical range for depression, anxiety, somatization, and pain-related self-efficacy were determined as a function of pain chronification. RESULTS Stage of pain had a significant effect on all psychological and pain-related parameters in the expected direction. Alongside patients with stage III, patients with stage II showed higher levels of impairment regarding psychological factors. Furthermore, patients with stage III often had higher clinical scores than expected for depression, anxiety, and somatization. CONCLUSION These results confirm the validity and clinical relevance of the MPSS. Moreover, the psychological burden of the patients increased with the stage of pain. Therefore, psychological treatments are required that are tailored to patients' needs. Thus, measurement of the MPSS and psychological diagnostic assessments are recommended.
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Affiliation(s)
- Anne Köpnick
- Institut für Gesundheits‑, Ernährungs- und Sportwissenschaften, Europa-Universität Flensburg, Auf dem Campus 1, 24943, Flensburg, Deutschland.
| | - Petra Hampel
- Institut für Gesundheits‑, Ernährungs- und Sportwissenschaften, Europa-Universität Flensburg, Auf dem Campus 1, 24943, Flensburg, Deutschland
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Langenmaier AM, Amelung VE, Karst M, Krauth C, Püschner F, Urbanski D, Schiessl C, Thoma R, Klasen B. Subgroups in chronic low back pain patients - a step toward cluster-based, tailored treatment in inpatient standard care: On the need for precise targeting of treatment for chronic low back pain. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2019; 17:Doc09. [PMID: 31728134 PMCID: PMC6838656 DOI: 10.3205/000275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/04/2018] [Indexed: 01/14/2023]
Abstract
Objective: The purpose of this study was to find applicable clusters for the development of different treatment pathways in an inpatient multimodal pain-therapy setting based on the multifaceted nature of CLBP. Methods: Based on data of questionnaires (Hospital Anxiety and Depression Scale (HADS), Marburg Questionnaire on Habitual Health Findings (MFHW), quality of life assessment using the Short-Form 12 (SF 12)), a retrospective two-step cluster analysis involving a sample of chronic low back pain (CLBP) patients (N=320) was calculated. Subsequently, the clusters were precisely described and compared on the basis of further data collected during the patients' standard care: pain characteristics, socio-demographic data and the general state of health, psychological variables, therapy intensity, and Diagnosis Related Groups (DRG) data. Results: We found a three-cluster solution: little psychological interference but marginal physical and mental quality of life (Cluster 1); poor well-being, low physical quality of life, and marginal mental quality of life (Cluster 2); and heavy mental strain and marginal physical quality of life (Cluster 3). Conclusions: Similar to previous studies, our results suggest that patients suffering from CLBP differ with regard to the magnitude of mental burden and the presence of physical impairment. These differences ascertain the need for precise targeting of treatment for CLBP. Inpatient pain centers therefore should offer different multimodal therapy pathways and integrate a meaningful triage, taking into account the multifaceted nature of CLBP based on sophisticated knowledge about forms, differences, and relationships among the biopsychosocial components of CLBP.
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Affiliation(s)
| | - Volker Eric Amelung
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Germany
| | - Matthias Karst
- Institut für Anästhesie und Intensivmedizin, Medizinische Hochschule Hannover, Germany
| | - Christian Krauth
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Germany
| | - Franziska Püschner
- inav - Privates Institut für angewandte Versorgungsforschung, Berlin, Germany
| | - Dominika Urbanski
- inav - Privates Institut für angewandte Versorgungsforschung, Berlin, Germany
| | - Christine Schiessl
- Algesiologikum - Zentren für Schmerzmedizin, Tagesklinik für Schmerzmedizin, Munich, Germany
| | - Reinhard Thoma
- Algesiologikum - Zentren für Schmerzmedizin, Algesiologikum MVZ Munich, Germany
| | - Bernhard Klasen
- Algesiologikum - Zentren für Schmerzmedizin, Algesiologikum MVZ Fürth, Germany
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[Interdisciplinary pain assessment in the hospital setting : Merely a door-opener to multimodal pain therapy?]. Schmerz 2019; 31:568-579. [PMID: 28717823 DOI: 10.1007/s00482-017-0237-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Landmann G, Dumat W, Egloff N, Gantenbein AR, Matter S, Pirotta R, Sándor PS, Schleinzer W, Seifert B, Sprott H, Stockinger L, Riederer F. Bilateral Sensory Changes and High Burden of Disease in Patients With Chronic Pain and Unilateral Nondermatomal Somatosensory Deficits: A Quantitative Sensory Testing and Clinical Study. Clin J Pain 2017; 33:746-755. [PMID: 27841837 PMCID: PMC5438869 DOI: 10.1097/ajp.0000000000000456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Widespread sensory deficits resembling hemihypoesthesia occur in 20% to 40% of chronic pain patients on the side of pain, independent of pain etiology, and have been termed nondermatomal sensory deficits (NDSDs). Sensory profiles have rarely been investigated in NDSDs. MATERIALS AND METHODS Quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS) was performed in the face, hand, and foot of the painful body side and in contralateral regions in chronic pain patients. Twenty-five patients with NDSDs and 23 without NDSDs (termed the pain-only group) were included after exclusion of neuropathic pain. Comprehensive clinical and psychiatric evaluations were carried out. RESULTS NDSD in chronic pain was associated with high burden of disease and more widespread pain. Only in the NDSD group were significantly higher thresholds for mechanical and painful stimuli found in at least 2 of 3 regions ipsilateral to pain. In addition, we found a bilateral loss of function for temperature and vibration detection, and a gain of function for pressure pain in certain regions in patients with NDSD. Sensory loss and gain of function for pressure pain correlated with pain intensity in several regions. DISCUSSION This may indicate a distinct sensory profile in chronic non-neuropathic pain and NDSD, probably attributable to altered central pain processing and sensitization. The presence of NDSD in chronic non-neuropathic pain may be regarded as a marker for higher burden of pain disease.
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Affiliation(s)
- Gunther Landmann
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Wolfgang Dumat
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Niklaus Egloff
- Psychosomatic Division, C.L. Lory-Haus, Department of General Internal Medicine, Inselspital, University Hospital, Bern, Switzerland
| | | | - Sibylle Matter
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Roberto Pirotta
- Department of Psychiatry, University Hospital, Zurich, Switzerland
| | - Peter S. Sándor
- University of Zurich, Zurich, Switzerland
- ANNR Neurology, RehaClinic, Baden, Switzerland
| | | | - Burkhardt Seifert
- Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Heiko Sprott
- University of Zurich, Zurich, Switzerland
- Medical practice Hottingen, Zurich, Switzerland
| | - Lenka Stockinger
- Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland
| | - Franz Riederer
- University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital, Zurich, Switzerland
- Neurological Center Rosenhuegel & Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
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Abstract
BACKGROUND AND OBJECTIVES Trauma patients often suffer from persisting pain even years after injury, and data on long-term pain management is lacking. The aim of this study was to evaluate the frequency of persisting pain and health-related quality of life (HrQoL) among trauma victims 2 years after injury. Furthermore, the frequency of pain specialist consultation and the quality of outpatient pain management, including phamacological management, was assessed. MATERIALS AND METHODS We analyzed prospectively collected data on severely injured adult patients treated between 2008-2011 at the Cologne Merheim Medical Center (CMMC)/Germany. Data included the 'Polytrauma Outcome Profile' and a standardized questionnaire on outpatient pain management. Exclusion criteria were death, inability to answer the questionnaire due to cognitive disabilities and lack of language knowledge. RESULTS AND CONCLUSIONS 207/391 (53 %) data sets were available for analysis, presenting a typical trauma collective with injury severity of ISS 19, predominantly male and a mean age of 44 years. 2 years after trauma 59 % still reported that they suffered from severe persisting pain; 53 % of these patients were under pharmacological pain medication. Only 1/5 of the patients with severe persisting pain was treated by a pain specialist. Successful treatment options do exist; improvement of treatment is required.
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Mahnig S, Landmann G, Stockinger L, Opsommer E. Pain assessment according to the International Spinal Cord Injury Pain classification in patients with spinal cord injury referred to a multidisciplinary pain center. Spinal Cord 2016; 54:809-815. [DOI: 10.1038/sc.2015.219] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 01/29/2023]
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Maihöfner CG, Heskamp MLS. Treatment of peripheral neuropathic pain by topical capsaicin: Impact of pre-existing pain in the QUEPP-study. Eur J Pain 2013; 18:671-9. [PMID: 24259265 PMCID: PMC4238838 DOI: 10.1002/j.1532-2149.2013.00415.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 01/17/2023]
Abstract
Background This study evaluates the impact of the duration of pre-existing peripheral neuropathic pain on the therapeutic response to the capsaicin 8% cutaneous patch. Methods The non-interventional QUEPP (QUTENZA – safety and effectiveness in peripheral neuropathic pain) study evaluated the effectiveness of Qutenza™ in 1044 non-diabetic patients with peripheral neuropathic pain, who received a single application. Follow-up visits were scheduled at weeks 1–2, 4, 8 and 12. A pre-defined co-analysis of changes in average pain intensity was performed based on the duration of pre-existing pain. Results In patients with pre-existing pain for <6 months, the mean relative change of the numeric pain rating scale score on days 7–14 to week 12 versus baseline was −36.6% [4.6 standard error of the mean (SEM); n = 105], −25.1% (1.9 SEM; n = 311) in patients with pain duration of 6 months to 2 years, −22.3% (1.6 SEM; n = 391) in patients with pain for >2–10 years, and −19.2% (2.6 SEM; n = 99) in patients with pain for >10 years. Thirty percent and 50% responder rates were 61.7% and 39.3% in patients with pre-existing pain for <6 months, 42.3% and 23.3% in patients with pain for 6 months to 2 years, 40.9% and 21.6% in patients with pain for >2–10 years, and 32.3% and 14.1% in patients with pain for >10 years. Conclusions The highest treatment response to the capsaicin 8% cutaneous patch was observed in patients with a history of pre-existing peripheral neuropathic pain of less than 6 months, suggesting that early initiation of topical treatment might be indicated.
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Affiliation(s)
- C G Maihöfner
- Fürth Hospital, Department of Neurology, University of Erlangen-Nuremberg, Germany
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[German pain questionnaire and standardised documentation with the KEDOQ-Schmerz. A way for quality management in pain therapy]. Schmerz 2012; 26:168-75. [PMID: 22527646 DOI: 10.1007/s00482-011-1142-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
KEDOQ-Schmerz was developed by the German Pain Society (formerly DGSS) as a basic tool for documentation and quality management of pain therapy. It is planned to use KEDOQ-Schmerz as the data basis for nationwide, cross-sectional and independent scientific research in health services in Germany. With comparatively little effort, each participating institution (practices, pain clinics) will be able to provide quality control of their own diagnostic procedures and therapeutic effects by using benchmarking. In future KEDOQ-Schmerz will also be used as a method for external quality management in pain therapy in Germany.
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