Der Schmerz
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Cross-sectoral clinical pathways for chronic pain patients in standard and routine care are a major challenge for the German healthcare system. The Algesiologikum group has developed such clinical pathways including an essential infrastructure. ⋯ The range of treatment in the hospitals includes multimodal, invasive and surgical pain therapy. The present report illustrates possibilities and frontiers of the Algesiologikum concept based on all patients treated since 2009.
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Review Comparative Study
[Integrated headache care network. Kiel Migraine and Headache Center and German National Headache Treatment Network].
Migraine and other headaches affect 54 million people in Germany. They rank among the ten most severely disabling complaints and the three most expensive neurological disorders. Nevertheless, they are not adequately recognized in the healthcare system with sketchy diagnoses and inadequate treatment. ⋯ A national network of outpatient and inpatient pain therapists in both practices and hospitals works hand in hand to optimally alleviate pain in a comprehensive cross-sectoral and multidisciplinary manner. For therapy refractive disorders, a high-intensive supraregional fully inpatient treatment can be arranged. This concept offers for the first time a nationwide coordinated treatment without limitation by specialization and bureaucratic remuneration sectors.
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Selective agreements offer the possibility to the health insurers to influence the control of care, a chance that they urgently need because of cost pressure. The concepts of care can be developed top-down and then a health insurer can make an offer. ⋯ Pathways are necessary for controlling the treatment which not only have to be developed but also have to be put into practice. The pathway acute sacroiliac pain developed by the Lübeck doctors' network will be described here as an example of a successful implementation.
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Randomized Controlled Trial
[Phantom limb pain. Psychological treatment strategies].
Similar to other pain syndromes phantom limb pain is characterized by learning and memory processes that maintain the pain and increase maladaptive plastic changes of the brain: therefore, psychological interventions that change maladaptive memory processes are useful. In addition to traditional psychological interventions, such as pain management training and biofeedback, more recent developments that involve sensory discrimination training, mirror treatment, graded motor imagery, prosthesis training and training in virtual reality are interesting. These interventions not only reduce phantom limb pain but also reverse the associated maladaptive brain changes.