Der Schmerz
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The importance of opioids in the treatment of non-cancer pain is under debate. No current data are available from Germany on the prevalence of opioid treatment for non-cancer pain. ⋯ Opioid therapy for non-cancer-related pain is predominantly carried out by general practitioners in older and multi-morbid patients. The indication for or against opioid therapy requires shared decision-making with patients and, if necessary, their relatives, as well as a review of possible drug interactions.
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Pain medicine is an interdisciplinary and interprofessional field of specialisation. Due to concerns about new recruits and an aging workforce, especially among physicians, it is important to better understand professional and career pathways in pain medicine. ⋯ The results emphasise the critical perspectives regarding the future provision of care for people with chronic pain. The results provide, for the first time, an insight into the career routes of staff in the field of pain medicine and their motivations and job satisfaction, which should be considered in the discussion about ensuring personnel resources in the future.
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Interdisciplinary multimodal pain therapy (IMPT) is mostly run in a group setting to encourage the exchange of experiences between patients and thus facilitate the change of pain-related attitudes and behavior. As is known from psychotherapy research, the fellow patients in a therapy group have a relevant influence on the success of the therapy for the individual patient. ⋯ Despite methodological limitations our results suggest that in patient groups of an IMST, patients with therapy experience and those with advanced cognitive behavioral methods for pain management should be combined with novices and patients who are still at the beginning of coping with the chronic pain disorder.
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Comparative Study
[Concept-dependent and -independent care effects of site-specific care concepts using "pain" as an example].
Structures of palliative care, cross-sectoral transitions and care pathways of patients with palliative care needs were investigated at two sites. The systematic comparison of similarities and differences using the topic of 'pain' as an example is intended to provide information on the extent to which these are related to site-specific palliative care concepts (integrated and cooperative). ⋯ Commonalities and differences with regard to the topic of pain, as focused on here, and its organisational management become tangible as effects of the respective organisational structure (= concept-dependent) as well as concept-independent external influencing factors.
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Surgical procedures for treating neuropathic pain, including trigeminal neuralgia (TGN), are categorized into three groups: decompression, ablation, and neuromodulation. Microvascular decompression is the only causal therapy for TGN, applicable favorably in cases of classical TGN due to a vascular nerve conflict. ⋯ For irreversible neuropathies of the trigeminal nerve, the algorithm for other neuropathic pain conditions should be considered, along with the potential use of neuromodulatory techniques. When selecting a therapy, diagnosis, medication side effects, individual patient risks, and treatment outcomes must all be taken into account (current S1 guideline from the German Society of Neurology).