[Structure of pain management facilities in Germany : Classification of medical and psychological pain treatment services-Consensus of the Joint Commission of the Professional Societies and Organizations for Quality in Pain Medicine].

On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine.

[Recommendations of the updated LONTS guidelines. Long-term opioid therapy for chronic noncancer pain].

Background: The regular update of the German S3 guidelines on long-term opioid therapy for chronic noncancer pain (CNCP), the"LONTS" (AWMF registration number 145/003), began in November 2013.

Methods: The guidelines were developed by 26 scientific societies and two patient self-help organisations under the coordination of the Deutsche Schmerzgesellschaft (German Pain Society). A systematic literature search in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Scopus databases (up until October 2013) was performed.

[Recommendations on classification of German pain treatment services].

On behalf of the German chapter of the International Association for the Study of Pain (IASP) recommendations for German pain treatment services have been developed for the first time. The criteria were based on the IASP recommendations but adapted to the specific German situation. According to the structure and process criteria four different levels of pain treatment services can be distinguished.

[Chronic pain in German medical practices. Current demands placed on the primary health care system due to pain prevalence].

Background: The prevalence of chronic pain as related to the supply situation in primary care has been investigated insufficiently.

Patients And Methods: A questionnaire was used to collect data of 1,201 patients in 6 different specialists' practices (general medicine, surgery, internal medicine, neurology, oncology, orthopaedics). The questions posed related to socio-demographic facts, pain characteristics, psychosocial effects, previous therapies and their subjective effectiveness.

[Quality characteristics concerning pain therapy].

The Institute of Medicine (IOM) reports "Crossing the Quality Chasm proposed 7 aims for high-quality healthcare: effective, safe, timely, efficient, equitable, patient-centred, and emphasized care coordination. The quality of pain treatment can also be shown by structure quality, process quality, and outcome quality. The present investigation shows methods of the qualitative capture of pain therapy.

Chronic pain in primary care. German figures from 1991 and 2006.

Background: Until now only limited research has been done on the prevalence of chronic pain in primary care. The aim of this investigation was to study the health care utilisation of patients suffering from pain. How many patients visit an outpatient clinic because of the symptom of pain? These data were compared with data from a similar study in 1991, to investigate whether improvements had been achieved.

[Influence of opioids on the psychomotor ability of patients in chronic pain].

Studies have provided no evidence that effective and stable long-term opioid treatment of pain necessarily impairs psychomotor abilities. Assessment of psychomotor abilities, especially of those involved in driving, can only be made in the individual case. Such abilities are affected especially by drug combination and such individual factors as age and driving experience.

[Ethic charter of the German Society for the Study of Pain (DGSS)].

The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people.

[Opioids: modern concepts of pain management].

In cancer pain management the application of opioids is established and follows the WHO guidelines. In the management of chronic non-cancer pain opioids are used increasingly but the effectiveness is less. Several central and gastrointestinal side effects can limit the outcome.

[Risk factors for substance abuse and dependence in opioid therapy for chronic noncancer-related pain].

Opioids are valuable analgesics, capable of providing pain relief and functional improvement not only in patients with cancer-related pain, but also in chronic noncancer-related pain patients. However, recent data have shown that the increasing prescription of opioids is associated with a rise in aberrant drug-related behaviour. The causes of this behaviour are multifactorial.

[Long-term efficiency of opioid medication in patients with chronic non-cancer-associated pain. Results of a survey 5 years after onset of medical treatment].

Unlabelled: A total of 121 patients with at least a 3-year history of opioid use were evaluated by a standardized interview during a clinical visit or telephone call. Assessed items were the present and former drug medication, daily doses, withdrawals, contentment with the treatment, positive/negative treatment effects, average/maximum pain and others.

Statistics: chi(2), ANCOVA and survival analysis.

[Safety-relevant performance of patients on chronic opioid therapy].

Aim: Is there a difference in performance and psychomotor function between patients on chronic opioid therapy and healthy controls and which factors influence the performance of the patients?

Methods: A total of 80 patients and 243 healthy controls were investigated with computer-based tests concerning concentration, coordination, reaction time, vigilance, and perception.

Results: The patients' results were worse in the test for concentration and better in the test for coordination than the results of the healthy controls. The results in the tests for reaction time, vigilance, and perception did not significantly differ between the two groups.

[Psychological abnormalities in patients with complex regional pain syndrome (CRPS)].

Question: Do comorbid psychological disorders, dysfunctional pain processing, and psychosocial pain coping occur with complex regional pain syndrome (CRPS) and is a connection between clinical and psychological manifestations apparent?

Methods: In addition to securing information on case histories and performing clinical neurological examinations of chronic CRPS patients, the structured clinical interview (SCID), pain perception scale, and the Kiel Pain Inventory were employed.

Results: The structured clinical interview revealed evidence of a depressive episode in 65% of CRPS patients. Pain perception is similar to neuropathic pain syndromes and patient history revealed a slightly increased frequency of anxiety and affective disorders.

[Epidemiology of chronic pain - an investigation in 5 medical practices].

Background And Methods: The aim of this study was to get more information about the prevalence of chronic pain in different practices of home physicians. 900 patients of five different specialists (general medicine, internal medicine, neurology, orthopaedics, surgery) in the german town Bochum were investigated with a questionnaire about chronic pain. Chronic pain was defined as a continuous or intermittend pain of longer duration than six months.

[Economic aspects of pain therapy].

Chronic pain has an economic impact for the society and the patients suffering from chronic pain. The indirect costs of chronic pain (loss of productivity, social security payments) are higher than the direct costs (prevention, diagnosis and therapy). The indirect costs in the family are often underestimated.

[Psychological pain therapy].

Psychologic strategies for the treatment of chronic pain are an important component of the necessary multidimensional treatment for patients in chronic pain. These techniques including relaxation training, biofeedback, hypnosis and cognitive-behavioral therapy have demonstrated efficacy. The impact of these techniques is on the sensory aspect of pain and the psychologic distress and on the maladaptive coping mechanism people develop in response to pain.

[Opioids and driving ability].

Introduction: Clinical observations of patients under oral opioid treatment suggest that the initially appearing central side effects such as sedation, dizziness or drowsiness decrease after a few weeks of treatment. However, it is still unclear whether long-term treatment with opioids impairs complex psychomotor functions such as driving a car.

Methods: Twenty patients on stable dosages of oral opioids were examined using a driving simulator.