Der Schmerz
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To investigate the development in palliative care education in Germany, numerous surveys have been conducted since 2006. They showed differences of palliative care education between the faculties before and after the implementation of palliative care as a mandatory subject. The present study aims to document the status of palliative care education at German medical faculties in 2018. ⋯ This study showed clear progression in palliative care education. Nevertheless, there is still room for improvement in terms of examination formats and professorships. Complementary surveys with students would be helpful to evaluate the education outcome.
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Nonopioid analgesics are frequently used for perioperative analgesia; however, insufficient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., for informing patients or for the timing of perioperative administration of nonopioid analgesics. ⋯ The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.
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Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. ⋯ Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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Review
[Management of endometriosis pain : Stage-based treatment strategies and clinical experience].
Endometriosis is associated with various types of intense pain. In addition to nociceptive pain, there is also a nociplastic reaction with central sensitization. Atypical symptoms such as acyclic lower abdominal pain, radiating pain, non-specific bladder and intestinal complaints or even depression are frequent as are classic cyclical complaints such as severe dysmenorrhea, cyclical lower abdominal pain, dyspareunia, dysuria and dyschezia. In cases of a diverse range of symptoms, patients often consult not just gynecologists but specialists from other disciplines (e.g., internal medicine, gastroenterology, orthopedics, pain therapy, psychology). ⋯ The use of multimodal treatment strategies regarding the complex pathophysiological aspects of this disease might be helpful in significantly improving the quality of life of endometriosis patients.
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The concept of chronic overlapping pain conditions (COPC) is relatively unknown in German pain medicine. ⋯ Pain physicians can play a role in the management of patients with endometriosis and COPCs. A multimodal therapy should include physiotherapy and pain-related psychological treatment and possibly centrally acting pain modulation medication.