Der Schmerz
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Clinical Trial Controlled Clinical Trial
[Less surgery and lower cost due to back pain in a care program with an interdisciplinary second opinion procedure : A controlled non-randomized intervention study based on claims data].
There is no evidence of effectiveness for interdisciplinary second opinion procedures (ISOP) for recommended back surgery (BS). Since 2015, AOK Nordost has been offering the care program RückenSPEZIAL comprising a preliminary examination, ISOP, and optional interdisciplinary multimodal pain therapy (IMPT). The objective of this study is to determine the effectiveness of RückenSPEZIAL to reduce BS and back pain-related costs (BPRC) compared to patients who likewise received a recommendation for back surgery but not RückenSPEZIAL. ⋯ The differences in BS were significant (p < 0.05) and in favor of RückenSPEZIAL. For the specific population it can be expected that mainly savings on BS can cover the intervention costs of RückenSPEZIAL (approximately significant, small case number). Bias due to self-selection needs to be assumed.
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Macromastia often leads to physical complaints involving pain in the shoulder/neck area. In Germany, there are virtually no reliable data on the effects of breast reduction surgery with regard to neck and spine complaints. Therefore, the authors carried out a retrospective study to investigate the effect of breast-reducing surgery on neck pain and quality of life. ⋯ With this study, the authors were able to show that there are often several reasons why breast reduction surgery is performed in patients with macromastia. A high patient satisfaction rate can be achieved and orthopedic clinical complaints associated with macromastia can be treated with a very high success rate.
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The article provides an overview of the research project "Metaphor in end-of-life care", which was conducted at Lancaster University (UK) between 2011 and 2014. The goals of the project were to show a) how patients, family members and healthcare professionals use metaphors to talk about their experiences with and expectations of end-of-life care, b) what experiences and needs are suggested by the use of metaphors by these groups and c) what contribution the results can make to communication in the healthcare system. ⋯ The use of metaphors by these groups suggests a need for solidarity and community and reflects both positive and negative personal experiences. Resilience can be understood as resistance against illness or as acceptance of it.
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A theological perspective on dealing with crises that focuses on modes of endurance and gestalt, is supported by interdisciplinary resilience research. ⋯ In order for silence to promote resilience, it is necessary to keep an eye on productive as well as destructive processes of silence as an ambivalent phenomenon: These processes occur in an uncontrollable way and are shaped by implicit normative assumptions. Silence can be experienced as loneliness, isolation and the loss of quality of life, or silence can become a place of encounter, of arrival, of security, and in prayer of trust in God.
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There is currently an emphasis on the biopsychosocial concept of pain in pain therapy programs. However, the complexity of chronic pain, in particular its importance for those affected by it, can only be insufficiently captured with this concept. This is due to the fact that, to date, one core aspect of the phenomenon chronic pain has only rarely been taken into account: its existential character. ⋯ Current treatment concepts, however, do not adequately consider the existential character of such challenges. Chronic pain should therefore always be perceived and treated from a holistic perspective. In this context, the aspects of recognizing its uniqueness, helping to express the pain and giving space to the experience are to be given special consideration in order to support chronic pain patients in dealing with their pain.