Der Schmerz
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There is no opioid crisis in Germany. However, new studies involving patients with chronic noncancer pain (CNCP) in Germany show an unexpectedly high prevalence of opioid use disorder according to DSM‑5 (Diagnostic and Statistical Manual for Psychiatric Diseases). ⋯ An adaptation of the DSM‑5 diagnostic criteria of opioid use disorder to the specific situation of CNCP patients and a validation of these criteria could help to collect more accurate data on opioid use disorders of patients with chronic pain in Germany in the future. Prescribers should be sensitized to this problem without pathologizing or even stigmatizing patients. Further research is needed to classify this previously underestimated phenomenon.
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Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. ⋯ Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
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Chronic pain is a worldwide problem of healthcare along with social and economic factors. The Center for Pain Medicine (CPM) Nottwil offers individualized, interdisciplinary, multimodal pain rehabilitation based on the biopsychosocial approach. The aim of this study was to obtain a real-life analysis of chronic pain patients who were treated at the CPM Nottwil, to understand how they were treated and to analyze the long-term effects of the treatment. ⋯ Individualized, interdisciplinary, multimodal and mostly outpatient pain programs are an effective treatment for patients suffering from chronic pain in the long term. For the first time this effect has been proven in a clinically representative cohort. Limitations of this study are low response rates in the follow-up group and differences in baseline characteristics (anxiety, depression and quality of life) between responders and non-responders.
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Parental cognitive-affective and behavioural responses impact on the chronification of the child's pain. Whether mothers and fathers differ in their responses and whether top-down variables (parental somatization, anxiety symptoms) and bottom-up variables (child's pain-related disability, anxiety symptoms) impact on parental responses remains unresolved. ⋯ As shown by previous studies, parental and child anxiety symptoms, but not parental gender, play a pivotal role in modulating parental maladaptive pain-related responses. This should be taken into account in prevention as well as in the treatment of children with chronic pain and their caregivers.
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Opioids efficiently alleviate pain and dyspnea. However, guidelines on symptom management with opioids differ, which may lead to an uncertainty concerning opioid indication and ethical implication among medical staff, especially when caring for COVID-19 patients. ⋯ DGP members perceived substantial uncertainty in the handling of M/O for medical fields outside PC. Uniform interdisciplinary guidelines for symptom control, more education, and involvement of a PC consultation team should be increasingly considered in the future.