Der Schmerz
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Every physician should be able to treat pain regardless of the specialty, but patients with a risk of chronification or chronic pain should receive care from specialized physicians and non-medical professionals. Specialized pain treatment is an additional qualification in Germany, which may be achieved in different specialties by defined structure criteria and experience. ⋯ However, the quality criteria suggested by the pain treatment societies were not always met. Treatment options for patients with a risk of chronification and chronic pain show regional variations and are insufficiently developed.
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It has been shown that long-term treatment with opioids does not necessarily impair driving ability in patients suffering from chronic pain. However, few studies are so far available on how increases in daily opioid dosage affect driving ability. ⋯ Seven days after an increase in the daily dose of an opioid or after the initiation of opioid therapy there was no general deterioration in patients' driving ability at group level.
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The results of conventional chronic back pain therapy are unsatisfactory. Deconditioning, psychosocial disorders and prolonged disability are common sequelae. ⋯ Patient selection by a health fund, interdisciplinary assessment and severity adapted treatment resulted in significant reduction in pain and functional improvement in disabled back pain patients.
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Practice Guideline
[Alternative and complementary therapies in fibromyalgia syndrome].
Interdisciplinary S3 level guidelines were devised in cooperation with 8 medical, 2 psychological and 2 patient support groups. Results were elaborated in a multilevel group process. ⋯ Within a multicomponent therapy setting, selective CAM therapies (acupuncture, vegetarian diet, homeopathy, Tai Chi, Qi Gong, music-oriented and body-oriented therapies) can be recommended for a limited period of time.
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A guideline for the treatment and diagnostic procedures in fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. ⋯ Psychotherapeutic programs tailored to FMS subgroups should be developed and tested.