Der Schmerz
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In many model regions of Germany, palliative home care can be improved for cancer patients over longer periods so that most of these patients could die at home. However, there is a shortage of ambulatory care for dying patients in regions without special agreements for this type of care. ⋯ Palliative symptom control in outpatients should be performed by qualified and interdisciplinary palliative-care teams, so that patients can receive more psychosocial support and hospital stays can be prevented.
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A multidimensional assessment of chronic pain is the most important tool for diagnosis and treatment. While the German Pain Questionnaire is routinely implemented in the treatment of adults with chronic pain, similar questionnaires are scarce for children and adolescents. It was the aim of the present study to report on the development and quality of a multimodal questionnaire assessing all relevant aspects of chronic pain in children and adolescents. The quality of the questionnaire was assessed (1) by implementing the questionnaire in a sample of children and adolescents suffering from chronic pain (aged 4-18 years), (2) by analysing missing items in the child, adolescent and parent version and (3) by analysing experts' ratings of the questionnaire. ⋯ The DSF-KJ provides a standardized assessment and comprehensive description of paediatric chronic pain problems and facilitates medical and psychological diagnostic and therapeutic decisions. The preliminary results suggest that the questionnaire is a clinically useful and practical assessment tool for children and adolescents with chronic pain.
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The ICD classification does not provide the opportunity to adequately identify pain patients. Therefore we developed an alternative method for the identification and classification of pain patients which is based on prescription and diagnoses data from the year 2006 of one nationwide sickness fund (DAK) and which is led by two main assumptions: 1. Beneficiaries without prescription of an analgetic drug but with a diagnosis pattern that is characteristic of patients who are treated with opioids are also likely to be pain patients. 2. ⋯ The selection of this diagnosis group (CCS) allows for the allocation of the beneficiary to only one pain type. As a result we identified 65 combinations of CCS diagnosis groups--aggregated to nine "CCS pain types"--to which 77.1% of all patients with at least two opioid prescriptions can be allocated: 26.3% to pain due to arthrosis, 18.0% to pain due to intervertebral disc illnesses, 13.1% to other specific back pain, 6.7% to neuropathic pain, 4.5% to unspecific back pain, 4.2% to headache, 2.4% to pain after traumatic fractures, 1.3% to pain of multimorbid, high-maintenance patients, and 0.6% to cancer pain. Based on our method beneficiaries who have a high probability of suffering from moderate to strong pain can be identified and included in further claims data analyses of health care delivery and utilization pattern of pain-related disorders in Germany.
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Injuries of the pudendal nerve, due to a perineal tear during delivery for example, can cause significant and debilitating neurological deficits. Aconuresis and anal incontinence, as well as sensory loss of the outer genitals or even impotency in men are the well known consequences. In addition some patients suffer from a severe neuropathic pain syndrome which is resistant to conservative treatment options. Epidural spinal cord stimulation at the level of the terminal cone of the spinal cord may be a new and successful therapeutic concept in otherwise untreatable cases.