Der Schmerz
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Chronic pain requires graduated and staged levels of care. The aim of this study is to provide a regional overview regarding the accessibility of specialized outpatient and (partial) inpatient pain medicine care from the patient's perspective in Germany. ⋯ The results show relevant nationwide differences in the accessibility of facilities for specialized pain treatment depending on the place of residence. Considering the treatment of a chronic condition with long-term therapeutic goals and the need for graduated care (outpatient and inpatient treatment), the results reveal a partly critical situation from the patient's perspective.
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The COVID-19 pandemic led to significantly restricted access to pain medicine services. Patients with cancer-related pain are considered a vulnerable group in terms of care deficits. A questionnaire among providers providing treatment to this group was used to assess limitations and solutions in this critical situation. ⋯ The COVID-19 pandemic revealed numerous deficits in the care of patients with cancer-related pain, as well as burdens on healthcare providers. The development of new concepts could help to ensure better care in future crisis situations.
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Treatment of sciatica due to lumbar disc herniation can be surgical or conservative. Conservative management has been described to be effective in 90% of patients; however, in most studies no consistent treatment concept was used. ⋯ The combined nonsurgical operative treatment program is effective and well tolerated.
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Current guidelines recommend a personalized, multimodal, and interdisciplinary approach for the treatment of chronic pain. Already in the acute treatment of postoperative pain, it can be useful to minimize risk factors for chronification. Auricular vagus nerve stimulation (aVNS) could be an effective non-drug therapy for the treatment of chronic and acute pain. ⋯ This review indicates that aVNS can be a complementary and effective non-drug treatment for patients with chronic and acute postoperative pain. Future studies in these indications should focus on standardizing and optimizing treatment parameters, inclusion of quality-of-life outcome parameters, and longer follow-up periods to better understand the sustainable therapeutic effect of aVNS.