Der Schmerz
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Review
[Prevention of chronic pain in the German healthcare system : Current state and perspective].
The current healthcare provision in Germany is established, in particular, for the diagnostics and treatment of chronic pain conditions; however, the current aim is to initiate the diagnostic and therapeutic approaches oriented towards the biopsychosocial pain model in the early stages of pain, i.e. before the onset of chronification, for patients with pain and a risk of chronification in order to actively avoid chronification processes. In this context, multiple risk factors play an important role for the diagnostic and therapeutic approaches as well as for the interdisciplinary multimodal pain therapy developed for this purpose. The Global Year of the International Association for the Study of Pain (IASP) 2020 addressed the prevention of (chronic) pain, a welcome opportunity to provide a short review of the evidence for and clinical experiences with timely diagnostic and therapeutic options and to summarize the current framework conditions and scientific recommendations for Germany. At the end of this article the implications for future research are summarized, particularly for the treatment of patients with pain and risk of chronification.
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Approximately 10% of the German population report chronic pain that has at least a moderate influence on everyday life. For instance, patients in Germany often experience an oversupply of diagnostics and therapy when suffering from mild back pain, while the care of patients with severe, chronic pain remains insufficient. Multimodal and interdisciplinary therapies are generally too seldomly used. ⋯ The main objectives are to: (1) Strengthen basic research to investigate the underlying mechanisms of pain development and maintenance as well as of chronification processes; (2) improve patient care by adequate application of diagnostic, therapeutic, and preventive procedures; (3) consolidate interdisciplinarity in pain research and patient care; (4) maintain participation of patients in social and in everyday life; and (5) achieve and maintain high quality standards in pain patient care. The following article provides an overview of the measures and advances currently being taken in pain research in Germany to close the above-mentioned gaps. The focus lies on current and future developments in the field of pain prevention.
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The question of pain prevention is becoming increasingly important, both in society and in science. According to the International Society for the Study of Pain, general areas for which pain prevention measures can be recommended have been defined. These approaches are mostly limited to unspecific recommendations with the aim of improving general health behaviour. ⋯ A selective literature search was carried out to this end. Based on selected studies, psychological and social predictors of pain development are presented and their potential for future pain prevention programs discussed. The article concludes with a discussion of possible implications.
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Palliative care serves to improve the quality of life in patients suffering from incurable diseases. Pharmacotherapy of distressing symptoms plays an important role. Off-label use refers to the use of drugs outside the marketing authorization. ⋯ For treatment planning and realization of off-label therapy in clinical practice, patient-related aspects, information, therapy monitoring and documentation of therapy effects should be considered in addition to drug-related information. Only in this way it is possible to offer a scientifically adequate, appropriate and economic therapy that is linked to an appropriate risk-benefit ratio for the individual patient. Due to the lack of authorization studies, reporting is of particular importance.