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Kaiser M, Brambrink S, Benditz A, Achenbach L, Gehentges M, König MA. Increase in Lower Limb Strength after Multimodal Pain Management in Patients with Low Back Pain. Medicina (B Aires) 2022; 58:medicina58070837. [PMID: 35888556 PMCID: PMC9319983 DOI: 10.3390/medicina58070837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The aim of the present study was to evaluate the efficacy of a multimodal pain therapy (MPM) regarding the objective parameter muscle strength of segment-dependent lower limb muscle groups before and after such a treatment. Materials and Methods: 52 patients with a history of low back pain and/or leg pain received standardized multimodal pain management. Strength of segment indicating lower limb muscles were assessed for each patient before and after ten days of treatment by handheld dynamometry. Results: Overall strength increased significantly from 23.6 kg ± 6.6 prior to treatment to 25.4 ± 7.3 after treatment, p ≤ 0.001. All muscle groups significantly increased in strength with exception of great toe extensors. Conclusions: Despite lower basic strength values at the beginning of treatment, all investigated muscle groups, except for the great toe extensors, showed a significant increase of overall strength after completion of the multimodal pain management concept. Increased overall strength could help with avoiding further need of medical care by supporting patients’ autonomy in daily life activities, as well as maintaining working abilities. Thus, our study is the first to show a significant positive influence on lower limb strength in patients with low back pain after a conservative MPM program.
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Affiliation(s)
- Moritz Kaiser
- Department of Orthopedic Surgery, Regensburg University Medical Center, 93077 Bad Abbach, Germany; (S.B.); (M.G.); (M.A.K.)
- Correspondence: (M.K.); (A.B.)
| | - Sara Brambrink
- Department of Orthopedic Surgery, Regensburg University Medical Center, 93077 Bad Abbach, Germany; (S.B.); (M.G.); (M.A.K.)
| | - Achim Benditz
- Department of Orthopedic Surgery, Regensburg University Medical Center, 93077 Bad Abbach, Germany; (S.B.); (M.G.); (M.A.K.)
- Correspondence: (M.K.); (A.B.)
| | - Leonard Achenbach
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, 97074 Würzburg, Germany;
| | - Matthias Gehentges
- Department of Orthopedic Surgery, Regensburg University Medical Center, 93077 Bad Abbach, Germany; (S.B.); (M.G.); (M.A.K.)
| | - Matthias Alexander König
- Department of Orthopedic Surgery, Regensburg University Medical Center, 93077 Bad Abbach, Germany; (S.B.); (M.G.); (M.A.K.)
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Raqué J, Chung BY, Benrath J. [Effectiveness of inpatient interdisciplinary multimodal pain therapy (IMPT) in patients with complex regional pain syndrome (CRPS) : A retrospective study]. Schmerz 2021; 36:81-88. [PMID: 34170399 DOI: 10.1007/s00482-021-00563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The primary symptom of complex regional pain syndrome (CRPS) is pain. Interdisciplinary multimodal pain therapy (IMPT) is the gold standard of treatment. The purpose of this study was to identify the beneficial effect of inpatient IMPT on pain level, sensation, perception and impairment in patients with CRPS. QUESTION The aim of the present study was to examine the effect of full-term IMPT on pain intensity, pain perception, pain processing, and pain impairment in patients with CRPS. METHODS In 265 patients with CRPS, pain level was retrospectively assessed by the numeric rating scale for pain (NRS), the Pain Perception Scale (SES) and the Pain Management Questionnaire (FESV) at the beginning and end of IMPT. RESULTS There was a significant reduction in the average and highest pain level on the NRS, a significant improvement in the affective experience of pain and cognitive pain management, as well as pain-related mental impairment. All patients improved significantly in resting and relaxation techniques. With regard to pain-related helplessness and depression, patients with mental comorbidity benefitted most. Patients undergoing invasive procedures in the form of peripheral nerve blockage showed no significantly improved outcome with regard to the tested parameters. DISCUSSION The current study demonstrated that IMPT has a highly beneficial effect on the level, experience and processing of pain in patients with CRPS.
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Affiliation(s)
- Johanna Raqué
- Medizinischer Dienst Baden-Württemberg, Heinrich-von-Stephan-Str. 5, 68161, Mannheim, Deutschland.
| | - Boo Young Chung
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Osianderstr. 5, 72076, Tübingen, Deutschland. .,Klinik für Anästhesiologie und Operative Intensivmedizin, Schmerzzentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland.
| | - Justus Benrath
- Klinik für Anästhesiologie und Operative Intensivmedizin, Schmerzzentrum, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
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Manchikanti L, Singh V, Kaye AD, Hirsch JA. Lessons for Better Pain Management in the Future: Learning from the Past. Pain Ther 2020; 9:373-391. [PMID: 32410070 PMCID: PMC7648810 DOI: 10.1007/s40122-020-00170-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 12/24/2022] Open
Abstract
The treatment of noncancer pain in the United States and globally is met with significant challenges, resulting in profound physical, emotional, and societal costs. Based on this need, numerous modalities have been proposed to manage chronic pain, including opioid and nonopioid interventions as well as surgical approaches. Thus, the future of pain management continues to be mired in evolving concepts and constant debates. Consequently, it is crucial to understand the past as we move towards the future. The evolution of lessons for better pain management at present and for the future starting from the 1990s to the present date are reviewed and emphasized with a focus on learning from the past for the future. This review summarizes the evolution of multiple modalities of treatments, including multidisciplinary programs, multimodal therapy, interventional techniques, opioid therapy, other conservative modalities, and surgical interventions. This review emphasizes the individual, patient-centered development of an effective pain treatment plan after proper evaluation to establish a diagnosis. It includes measurable outcomes that focus on improvements in the quality of life and activities of daily living, as well as improvement in pain and function and, most importantly, return to productive citizenship. It is crucial that the knowledge of best practices be advanced, along with emphasis on lessons learned in the past to provide best practices for better pain management.
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Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Centers of America, Paducah, KY, USA.
- University of Louisville, Louisville, KY, USA.
- Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA.
| | - Vanila Singh
- Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Alan D Kaye
- Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
- Department of Anesthesiology, LSU School of Medicine, Shreveport, LA, USA
- Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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Oratsch C, Pipam W, Köstenberger M, Apich G, Likar R. [Treatment for chronic back pain? : Active multimodal, interdisciplinary pain therapy vs. physiotherapy-physical therapy for chronic back pain]. Schmerz 2019; 33:337-346. [PMID: 31098706 DOI: 10.1007/s00482-019-0379-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In industrialized countries, chronic back pain is referred to as the "number one common disease". OBJECTIVES Are there any indications of different outcomes of chronic back pain patients when treated with a multimodal, interdisciplinary pain therapy (MMSTh) compared to physiotherapy-physical therapy? MATERIALS AND METHODS Entrance and final examination by means of survey, questionnaires and physical tests in the intervention and control group, evaluation and comparison of the results. RESULTS The intervention group showed very significant improvements in all tests. In contrast, the control group achieved only partial improvements in physical parameters and quality of life. This resulted in clear group differences in favor of the MMSTh. In terms of patient satisfaction, the control group showed a better result than the intervention group. CONCLUSIONS Treatment with MMSTh is superior to standard physiotherapy-physical. Due to the extensive, proven positive effect on many pain-causing and pain-preserving factors, multimodal pain centers should be used more frequently in chronic back pain patients.
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Affiliation(s)
- C Oratsch
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich.
| | - W Pipam
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - M Köstenberger
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - G Apich
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - R Likar
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
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Preis MA, Vögtle E, Dreyer N, Seel S, Wagner R, Hanshans K, Reyersbach R, Pieh C, Mühlberger A, Probst T. Long-Term Outcomes of a Multimodal Day-Clinic Treatment for Chronic Pain under the Conditions of Routine Care. Pain Res Manag 2018; 2018:9472104. [PMID: 29808108 PMCID: PMC5901829 DOI: 10.1155/2018/9472104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/21/2018] [Accepted: 03/06/2018] [Indexed: 02/07/2023]
Abstract
Chronic pain has high prevalence rates and is one of the top causes of years lived with disability. The aim of the present study was to evaluate the long-term effects of a multimodal day-clinic treatment for chronic pain. The sample included 183 chronic pain patients (114 females and 69 males; 53.3 ± 9.8 years) who participated in a four-week multimodal day-clinic treatment for chronic pain. The patients' average current pain intensity (NRS), sensory and affective pain (Pain Perception Scale), and depression and anxiety (HADS) were assessed at pre- and posttreatment, as well as at three follow-ups (one month, six months, and twelve months after completion of the treatment). Multilevel models for discontinuous change were performed to evaluate the change of the outcome variables. Improvements from pretreatment to posttreatment and from pretreatment to all follow-ups emerged for pain intensity (NRS; 0.54 ≤ d ≤ 0.74), affective pain (Pain Perception Scale; 0.24 ≤ d ≤ 0.47), depression (HADS; 0.38 ≤ d ≤ 0.53), and anxiety (HADS; 0.26 ≤ d ≤ 0.43) (all p < 0.05). Sensory pain as assessed with the Pain Perception Scale did not show any significant change. Patients suffering from chronic pain benefited from the multimodal pain treatment up to twelve months after completion of the treatment.
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Affiliation(s)
- Mira A. Preis
- Georg-Elias-Müller Institute for Psychology, Georg-August University Göttingen, Göttingen, Lower Saxony, Germany
| | - Elisabeth Vögtle
- Georg-Elias-Müller Institute for Psychology, Georg-August University Göttingen, Göttingen, Lower Saxony, Germany
| | - Nele Dreyer
- Institute for Psychology, Regensburg University, Regensburg, Germany
| | - Stefanie Seel
- Institute for Psychology, Regensburg University, Regensburg, Germany
| | - Ruth Wagner
- Hospital Barmherzige Brüder, Regensburg, Germany
| | | | | | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | | | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
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Arnold B, Casser HR, Klimczyk K, Lutz J, Brinkschmidt T, Gralow I, Irnich D, Kaiser U, Nagel B, Schiltenwolf M, Pfingsten M, Sabatowski R, Söllner W. [Acute inpatient multimodal pain therapy and rehabilitation: Framework conditions, tasks and differentiated patient allocation]. Schmerz 2017; 29:641-8. [PMID: 26452370 DOI: 10.1007/s00482-015-0063-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Multimodal pain treatment programs are widely accepted as the medical treatment standard in the management of patients with chronic pain syndromes. The concepts and treatment strategies are based on the biopsychosocial model of pain and programs for early restoration of function. Although this concept is primarily implemented in the curative field, i.e. in hospitals for the treatment of patients with chronic pain diseases, modified programs based on the International Classification of Functioning (ICF) can now also be found in rehabilitation clinics. Despite the assumed similarities, significant differences in, for example the aims of the therapy and relevant structural and process variables have to be kept in mind when allocating patients to a program as provided by a hospital or a rehabilitation clinic. The aim of this article is to present the framework structures of both treatment levels with respect to the implementation of multimodal pain therapy programs and to elucidate the differential diagnostic approach to the indications.
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Affiliation(s)
- B Arnold
- Abteilung für Schmerztherapie, Helios Amperklinikum Dachau, Krankenhausstr. 15, 85221, Dachau, Deutschland.
| | | | - K Klimczyk
- Interdisziplinäres Schmerzzentrum, m&i-Fachklinik Enzensberg, Hopfen am See, Deutschland
| | - J Lutz
- Interdisziplinäre Schmerztherapie, Zentralklinik Bad Berka, Bad Berka, Deutschland
| | | | - I Gralow
- Schmerzambulanz und Schmerz-Tagesklinik, Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - D Irnich
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Universität München, München, Deutschland
| | - U Kaiser
- Universitäts SchmerzCentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - B Nagel
- DRK Schmerz-Zentrum, Mainz, Deutschland
| | - M Schiltenwolf
- Orthopädische Universitätsklinik, Heidelberg, Deutschland
| | - M Pfingsten
- Schmerztagesklinik und -ambulanz, Zentrum für Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - R Sabatowski
- Universitäts SchmerzCentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - W Söllner
- Klinik für Psychosomatische Medizin & Psychotherapie und Interdisziplinäre Schmerztagesklinik, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Nürnberg, Deutschland
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7
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Fehrmann E. Psychologische und psychotherapeutische Interventionen bei Patienten mit Rückenschmerzen. MANUELLE MEDIZIN 2016. [DOI: 10.1007/s00337-015-0081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deckert S, Kaiser U, Kopkow C, Trautmann F, Sabatowski R, Schmitt J. A systematic review of the outcomes reported in multimodal pain therapy for chronic pain. Eur J Pain 2015; 20:51-63. [DOI: 10.1002/ejp.721] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/14/2022]
Affiliation(s)
- S. Deckert
- Center for Evidence-Based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Germany
| | - U. Kaiser
- Comprehensive Pain Center; Universitätsklinikum Carl Gustav Carus; Dresden Germany
| | - C. Kopkow
- Center for Evidence-Based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Germany
| | - F. Trautmann
- Center for Evidence-Based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Germany
| | - R. Sabatowski
- Comprehensive Pain Center; Universitätsklinikum Carl Gustav Carus; Dresden Germany
- Department of Anesthesiology and Intensive Care; Universitätsklinikum Carl Gustav Carus; Dresden Germany
| | - J. Schmitt
- Center for Evidence-Based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Germany
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Brömme J, Mohokum M, Disch A, Marnitz U. Interdisziplinäre, multimodale Schmerztherapie vs. konventionelle Therapie. Schmerz 2015; 29:195-202. [DOI: 10.1007/s00482-014-1508-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mariana C, Carmen-Oana T. Massage versus Kinesio Taping. Possibilities to Enhance the Kinetic Program in Mechanically Triggered Neck Pain. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.sbspro.2014.02.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit. Scand J Pain 2013; 4:190-197. [PMID: 29913651 DOI: 10.1016/j.sjpain.2013.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
Background In recent years, multidisciplinary rehabilitation (MDR) became an alternative treatment option for chronic non-cancer pain. MDR is mostly available in specialized pain units, usually at rehabilitation centers where the level of knowledge and therapeutically options to treat pain conditions are considered to be high. There is strong evidence that MDR in specialized pain units is affecting pain and improves the quality of life in a sustainable manner. There are few studies about MDR outcome in primary health care, especially in those units situated in rural areas and with a different population than that encountered in specialized hospitals. That, in spite of the fact that the prevalence of pain in the patients treated in primary care practice is about 30%. The aim of this study is to analyze the effectiveness of MDR for chronic non-cancer patients in a primary health care unit. Methods This study included a total of 51 patients with chronic pain conditions who were admitted and completed the local MDR-program at the primary health care unit in Arvika, Sweden. The major complaint categories were fibromyalgia (53%), pain from neck and shoulder (28%) or low back pain (12%). The inclusion criteria were age between 16 and 67 years and chronic non-cancer pain with at least 3 months duration. The multidisciplinary team consisted of a general practitioner, two physiotherapists, two psychologists and one occupational therapist. The 6-week treatment took place in group sessions with 6-8 members each and included cognitive-behavioral treatment, education on pain physiology, ergonomics, physical exercises and relaxation techniques. Primary outcomes included pain intensity, pain severity, anxiety and depression scores, social and physical activity, and secondary outcomes were sick leave, opioid consumption and health care utilization assessed in the beginning of the treatment and at one year follow-up. Data was taken from the Swedish Quality Register for Pain Rehabilitation (SQRP) and the patients' medical journal. Results One year after MDR treatment, sick leave decreased from 75.6% to 61.5% (p <0.05). Utilization of health-care during one year decreased significantly from 27.4 to 20.1 contacts (p = 0.02). There were significant improvements concerning social activity (p = 0.03) and depression (p <0.05), but not in anxiety (p = 0.1) and physical activity (p = 0.08). Although not statistically significant, some numerical decrease in the mean levels of pain intensity, pain severity and opioid consumption were reported one year after MDR (p > 0.05). Conclusions The results obtained one year after rehabilitation indicated that patients with chronic noncancer pain might benefit from MDR in primary health care settings. Implications This study suggests that MDR in primary care settings as well as MDR at specialized pain units may lead to better coping in chronic non-cancer pain conditions with lower depression scores and higher social activity, leading to lower sick leave. This study demonstrated that there is a place for MDR in primary health care units with the given advantage of local intervention in rural areas allowing the patients to achieve rehabilitation in their home environment.
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Kaiser U, Arnold B, Pfingsten M, Nagel B, Lutz J, Sabatowski R. Multidisciplinary pain management programs. J Pain Res 2013; 6:355-8. [PMID: 23690699 PMCID: PMC3656892 DOI: 10.2147/jpr.s40512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ulrike Kaiser
- Comprehensive Pain Center, University Hospital "Carl Gustav Carus", Dresden
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13
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[Effectiveness of intensive multimodal pain management programs]. Schmerz 2010; 24:172-3; author reply 174, 176. [PMID: 20376608 DOI: 10.1007/s00482-010-0905-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wang H, Weinsheimer N, Akbar M, Schiltenwolf M. Veränderte Schmerzschwellen während und nach Opioidentzug bei Patienten mit chronischen Rückenschmerzen. Schmerz 2010; 24:257-61. [PMID: 20390305 DOI: 10.1007/s00482-010-0912-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H Wang
- Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 69118 Heidelberg.
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Schütze A, Kaiser U, Ettrich U, Große K, Goßrau G, Schiller M, Pöhlmann K, Brannasch K, Scharnagel R, Sabatowski R. Evaluation einer multimodalen Schmerztherapie am UniversitätsSchmerzCentrum Dresden. Schmerz 2009; 23:609-17. [DOI: 10.1007/s00482-009-0827-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schwarz S, Mangels M, Sohr G, Holme M, Worringen U, Rief W. [Patients with versus without psychological disorders in orthopedic rehabilitation]. Schmerz 2008; 22:67-74. [PMID: 18084781 DOI: 10.1007/s00482-007-0603-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND In this study it was examined whether orthopedic rehabilitants with versus without a comorbid mental disorder profit from inpatient orthopedic rehabilitation to the same degree. It was also investigated whether there were differential treatment effects between the traditional and behavioral-medical rehabilitation approaches. METHOD Questionnaires which assess pain-specific and associated variables were issued to a total of 361 patients on admission and discharge from rehabilitation. RESULTS In some aspects patients with a mental disorder benefited more from the treatment than patients without comorbidities. Differential treatment effects were found only in patients with a mental disorder and improvements were higher in the behavioral-medical than in the traditional rehabilitation approaches. CONCLUSION Psychological interventions in the inpatient orthopedic rehabilitation are recommended in order to adequately deal with the higher rate of persons with comorbid mental disorders.
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Affiliation(s)
- S Schwarz
- FB Psychologie - AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Gutenbergstr. 18, 35032, Marburg, Deutschland.
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[Pain clinics within Austrian hospitals, for patients with pathologies of the locomotor system. Analysis of care and comparison with Germany]. Schmerz 2007; 22:43-50. [PMID: 18000688 DOI: 10.1007/s00482-007-0596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper gives a comparative overview of the current clinical care of patients experiencing pain in the musculoskeletal system in Austria and in Germany. The questionnaire used in this study was modified from one used in a survey carried out in Germany in 2002. In our version we asked specifically about pain in the musculoskeletal system. In all 228 health care facilities were reviewed, 56.6% of which offer at least one option for pain therapy. In Austria, the majority of patients with pain in the musculoskeletal system are treated by specialists in the departments of anaesthesiology, internal medicine, and orthopaedics. In 17.4% of the clinics in Austria there are plans to extend the pain therapy they offer, but in over half of the hospitals that responded facilities for pain therapy are considered to be vulnerable. The study highlights a significant higher percentage of in-patient pain therapy services in Austria, while in Germany, in contrast, there are more outpatient options for pain therapy. The quality of pain therapy could by further improved by more intense cooperation between the inpatient and outpatient sectors and by the establishment of interdisciplinary and multimodal solutions.
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Mesrian A, Neubauer E, Schiltenwolf M. Gutes Therapieergebnis nach Behandlung chronischer Rückenschmerzen. Schmerz 2007; 21:212, 214-7. [PMID: 17497184 DOI: 10.1007/s00482-007-0543-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate how much change in pain intensity is necessary to discriminate between good, bad or no treatment outcome from the patient's point of view after therapy for chronic back pain. METHODS A total of 153 patients with chronic back pain were admitted to a 3 week multimodal treatment program including functional restoration and cognitive behavioral support (outpatient). Pain intensity was measured at the beginning of treatment and 6 months after discharge using a visual analogue scale (VAS). At this time, patients had to evaluate their back pain compared to the beginning of treatment as of better, equal or worse (global self-assessment). RESULTS Six months after therapy, 48% of the patients assessed their back pain as better, 28% reported no change and 14% stated that their pain was worse. Mean pain reduction among the patients who assessed themselves as better was 25 points, while those who stated that their pain was worse had an average of 9 points more (VAS). CONCLUSION Patients' global self-assessment is a valid parameter to determine the outcome after treatment of chronic back pain. A clinically meaningful pain reduction can be assumed if there is at least a 25/100 point reduction (VAS), while a worsening of pain is already found to be important when there is a rise of 9/100 points.
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Affiliation(s)
- A Mesrian
- Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg.
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