Der Schmerz
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Multicenter Study Controlled Clinical Trial
["Back pain coach". A project for patients with back pain].
Back pain is a challenge for case management but is a health insurance fund (HIF) that identifies high risk patients and includes them in a back pain assessment and a multimodal program cost-effective? ⋯ The HIF was responsible for the study investment and project partners shared the training of the HIF regional case managers.
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Chronic pain is a widespread social problem. This paper reports on the care situation for patients with chronic pain in out-patient community settings in Austria. ⋯ Quality criteria relating to the structure of care established by the Austrian Society for Pain have only been partially implemented. Potential for improvement exists particularly with regards to the prevalence of pain-specific training, interdisciplinary teamwork and the measurement of outcomes.
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Patients' readiness to behavioural changes according to the transtheoretical model (TTM) and criteria of treatment outcome are positively associated and have in part already been confirmed. For a stable effect of therapeutic treatment, patients' readiness to change seems indispensable for an independent and active pain management. Thus, in addition to an enhanced quality of life, increasing patients' motivation is a declared objective of the treatment at Dresden's Comprehensive Pain Center. In this study, it was examined how the readiness to change develops in the course of and during the 2 years following the multimodal treatment program. Furthermore, associations between outcome criteria of the treatment and patients' readiness to change were explored. ⋯ The results indicate that the outpatient pain management program favorably affects patients' motivation and general quality of life. This effect also seems to be stable over a long period of time. As not all patients show an improvement in stage of readiness to change, the question arises whether the reason of the differences might lie within the patients' and whether specific interventions for motivation might be useful to enhance motivation before starting treatment.
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Levomethadone is a strong opioid which is used rarely in the treatment of special pain syndromes in Germany. A main field for the usage of Levomethadone, which has be applied as a oral fluid, is the opioid replacement therapy of heroin-addicts. ⋯ The conversion starts with a low start dose, an individual titration follows. In this case-report, the difficulty of cumulation, inaccurate drug dispensary and the characteristic of dosage calculation of levomethadone is discussed.
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Review
[Methods and development of therapy recommendations for symptom control in palliative medicine].
The Drug Commission of the German Medical Association has decided to develop treatment guidelines for palliative care. A series of systematic reviews was commissioned to evaluate the evidence for interventions of common symptoms that burden patients and care givers. A common methodology for all reviews is described in this paper. ⋯ Every review graded the quality of the included evidence following categories of the Drug Commission of the German Medical Association. Based on these results and recommendations the treatment guidelines will be formulated which will offer concise and evidence-based guidelines for general palliative medicine, offering primary care givers guidance for adequate palliative care in severely ill and dying patients. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").