[Prevention of chronic pain in the German healthcare system : Current state and perspective]

[Is the relationship between depressive symptoms and work-related factors mediated by pain self-efficacy in non-specific chronic low back pain?]

BACKGROUND

The transition from acute to non-specific chronic low back pain (CLBP) is especially associated with psychological factors. However, working mechanisms of psychological factors have been little examined in non-specific CLBP, especially the mediator effect of pain self-efficacy.

OBJECTIVE

Does pain self-efficacy mediate the long-term prediction of work-related factors by depressive symptoms?

METHODS

Within the framework of an exploratory secondary analysis, simple mediation analyses were conducted to longitudinally predict prognosis of gainful employment, as well as subjective physical and mental work ability by depressive symptoms mediated by pain self-efficacy in 382 inpatients with non-specific CLBP.

RESULTS

The findings suggest that depressive symptoms prior to rehabilitation predicted levels of all three work-related factors 24 months after rehabilitation, and pain self-efficacy 12 months after rehabilitation mediated this relationship.

CONCLUSION

To improve the success of work-related rehabilitation in the long-term, pain self-efficacy in particular, but also depressive symptoms should be targeted by treatments of non-specific CLBP.

[Feasibility of the interdisciplinary multimodal assessment-The team perspective]

BACKGROUND

Secondary preventive outpatient diagnostic services for patients with pain and risk factors for chronification have not yet been sufficiently established. In the PAIN2020 project (Innovation Fund, 01NVF17049) an outpatient interdisciplinary multimodal assessment (IMA) was introduced for the first time early in the course of the disease.

OBJECTIVE

For the implementation of the IMA procedures for team cooperation and decision criteria were developed, which were implemented by a team of medical, physiotherapeutic and psychological therapists. These procedures and decision criteria are to be discussed against the background of clinical experience and examined with respect to their feasibility (qualitative).

METHODS

In PAIN2020 a workshop on IMA was held in September 2021 to jointly reflect on the findings and experiences gained in the process so far through monitoring and structuring documentation in the implementation with staff or teams of PAIN2020 centers on the feasibility of implementing a structured interdisciplinary multimodal assessment. In three work phases, occupational group-specific and cross-occupational group topics were addressed.

RESULTS

In the decision-making processes of the occupational groups, in addition to profession-specific focal points within the framework of the assessment of findings (somatic, functional or psychosocial core criteria), overarching core criteria within the professions as well as complementary patient-related aspects are evident, which are included in the integrative team process. With respect to team collaboration, the implementation of the team meeting and the final discussion can be used to identify structural and process parameters that promote or inhibit implementation, which are also accompanied by interactional factors.

DISCUSSION

For the implementation of the IMA, there were (1) adaptations of the IMA, which is currently implemented as A‑IMA in the selective agreement with BARMER and (2) new dimensions or task fields and ideas for evidence-based concepts for the content design of integrative diagnostics as well as for the feedback of the results to the patients, which should be discussed in the future.

[Specific therapy needs of young adults with chronic pain : Results of a qualitative interview study]

BACKGROUND

Young adults find themselves in an unstable phase of life with relationship breaks, falling structures and great challenges in life. Chronic pain makes it difficult to cope with this stage of life due to functional, emotional and social limitations. For this age group there are hardly any target group-specific treatment programs.

OBJECTIVE

The aim of the study was to find out what needs the patient group of young adults with chronic pain have with regard to inpatient pain therapy and what need is indicated for a separate therapy concept for this age group.

MATERIAL AND METHODS

Within the framework of a qualitative research approach, specific needs of young adults with regard to inpatient pain therapy were surveyed via guideline-based interviews. A total of 66 interviews were conducted with patients and practitioners. The evaluation was carried out using the method of structuring qualitative content analysis.

RESULTS

Five main categories regarding the specific treatment needs of young adult pain patients were identified: respect, belonging, special circumstances, locating the pain and specific elements of therapy.

CONCLUSION

Special living conditions and a respectful treatment attitude are of particular importance. A greater number of activation offers, a higher proportion of life counseling and perspective-creating aspects as well as psychotherapeutic offers are a necessity for an efficient therapy. Acceptance and commitment therapy techniques and the positive benefits of peer groups can expand the treatment approach for young adults. Young adults could benefit from a target group-specific and needs-adapted care structure.

[Psychosocial factors in pain and pain management : A statement]

Although psychosocial factors have a profound impact on the experience of pain and pain recovery, the transfer to clinical application has so far been insufficient. With this article, a task force of the special interest group "Psychosocial Aspects of Pain" of the German Pain Society (Deutsche Schmerzgesellschaft e. V.) would like to draw attention to the considerable discrepancy between existing scientific evidence on the importance of psychosocial factors in the development of chronic pain disorders and the translation of these findings into the care of pain patients. Our objective is a stronger integration of psychological and psychosomatic expertise in pain treatment and research, as well as the improvement of structural and institutional conditions, to achieve an increased consideration of psychosocial aspects. In this way, modern, integrative and complex pain concepts can reach the patient. Based on these fundamental findings on the importance of psychosocial factors in pain and pain treatment, implications for the transfer to clinic and further research will be shown.

[Prediction and prevention of chronic postoperative pain]

Chronic postoperative pain has been identified as a major medical and socioeconomic problem. A prevention of the chronification processes is potentially possible and preventive treatment could start early (e.g. preoperatively). So far, however, evidence for the effectiveness of preventive strategies is basically low. Important reasons for this dilemma are the lack of appropriate risk assessment as well as effective and mechanism-based preventive (procedure-sepcific) strategies for the chronification process, a lack of stratification of treatment approaches and a so far barely investigated combination of various treatment approaches. In this review article recent findings on the appropriate identification of patients at risk for developing postoperative chronic pain are presented, predictive models for the valid estimation of the individual risk of patients are assessed and studies on pharmaceutical and regional analgesia techniques influencing the pain chronification process are discussed. As a chronification process is, however, extremely complex and dynamic and also necessitates adaptation of the prevention during the course of the process, only combinations of treatment, interdisciplinary and if necessary even longer term approaches might be successful. Future studies are needed to address with which preventive treatment strategies and in which patients chronic pain after surgery can effectively be prevented.