Der Schmerz
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Multicenter Study
[Health-related quality of life in patients with chronic pain].
An empirical comparison of the performance characteristics of 3 generic health-related quality of life (HRQL) measures in pain patients. ⋯ The SF-36 has satisfactory to good psychometric properties in pain patients, the NHP item selection has to be improved. The FLZ-M weighting can be eliminated. The shortcomings of the SF-36 can be overcome by adding short scales on role functioning and pain (modular approach).
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Palliative care in Germany fails to reach established standards. To improve this situation the Chamber of Physicians of Lower-Saxony initiated SUPPORT in 1995. Prior to interventions structural quality of care was evaluated, specifically the rate of availability of opioid-prescription-forms and the ability to treat chronic pain (defined as a construct of knowledge, attitudes and skills) were examined. ⋯ These results verify an insufficient structural quality in palliative care in Lower-Saxony. In the authors' opinion effective improvements can only be achieved by implementing a parallel strategy:improvement of basic knowledge in pain management with sufficient transfer of this knowledge into practice as well as raising the rate of availability of opioid-prescription-forms,and, on the other hand, establishing local palliative-care-teams with nursing and medical expertise with 24/7 on-demand availability to optimize palliative care.
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Chronic pain is the most frequent symptom leading to medical expertise in general medicine, orthopedics, neurology and psychiatry. Because of the importance of psychosocial factors in the onset and the course of chronic pain syndromes a basic psychosomatic diagnostic in every medical expertise of chronic pain is necessary. ⋯ The guidelines of the German psychosomatic and psychotherapeutic scientific societies for medical expertising are presented with their relevance to the assessement of patients with chronic pain syndromes. Furthermore the authors discuss based on their own experiences and the literature some controversial issues between medical experts and officials in charge of pension insurance companies.
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A committee of health specialists examined the demand characteristics and efficiency of German health care services and published an expertise on the misallocation of services that among other subjects also covered the area of low back pain. Although we agree with their principal statements, we like to underscore that the objectives mentioned in the report cannot be achieved without the participation of psychologists. ⋯ Psychologists investigated these mechanisms, developed interventions for the prevention and treatment of low back pain on the basis of the results, and tested their efficacy in trials with a high methodological standard. Incorporation of psychological expertise does not only optimise prevention and treatment of low back pain and helps to prevent unnecessary suffering of the afflicted, in addition, it offers a contribution a cost containment.
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Practice Guideline Guideline
[Morphine and alternative opioids in cancer pain: the EAPC recommendations].
An expert working group of the European Association for Palliative Care (EAPC) has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.