Background: In Germany, various forms of outpatient palliative care (PC) for oncological patients have been established for years. However, no data is available on how prescription rates of analgesics and supportive care vary depending on the specific form of outpatient PC. Methods: This retrospective cohort study analyzed data from 158,035 deceased statutory health insurance patients with advanced cancer between 2016 and 2021. Three groups were analyzed: patients without outpatient PC, with general outpatient PC or particularly qualified and coordinated PC (AAPV/BQKPmV), and with specialized outpatient PC (SAPV). The study focused on the prescription rates of various medication groups according to ATC codes (nonopioid and opioid analgesics, antineuropathic medication, antiemetics, systemic steroids, stool-regulating measures) and their combinations in the last month of life. Results: SAPV patients showed the highest prescription rates, e.g., strong opioids (71.8%), followed by AAPV/BQKPmV (47.2%) and patients without PC (22.5%). The prescription rates for all supportive medications showed similar patterns. An inverse pattern was observed for weak opioids: SAPV (5.8%), AAPV/BQKPmV (8.9%), and no PC (9.1%). The guideline-adherent combination of strong opioid analgesics and laxatives was implemented in less than half of the cases in SAPV (44.2%) and even less frequently in AAPV/BQKPmV (32.4%). Conclusion: This study provides comprehensive insights into medication prescription practices in outpatient PC in the last month of life, for the first time. The high prescription rates in SAPV reflects more intensive medication treatment of patients with possibly more complex symptoms in this specialized form of PC.
Back pain is among the leading causes of disability and work absenteeism worldwide. Approximately 85-90% of cases are classified as non-specific and mostly show an innocuous trajectory. Decisive for the guideline-conform management are the structured differentiation of specific causes, early identification of chronicity risk factors and an activating biopsychosocial treatment approach. Imaging should only be performed when clinically indicated. Exercise therapy represents the central conservative treatment modality. Pharmacotherapies are mainly used to support active rehabilitation strategies. Interdisciplinary multimodal programs improve long-term function, participation and quality of life, particularly in chronic pain conditions. Interventional procedures can be meaningful in selected patients with clearly defined indications.
Background: Long-term opioid use (> 3 months) can be an important element in the treatment of patients with chronic nontumor pain but it is also discussed in association with risks for the development of opioid use disorder. This analysis aims to explore the risk factors for opioid use disorder in long-term opioid treatment, barriers for its identification and starting points for different solutions to overcome these barriers from a medical perspective. Methods :A cross-sectional postal survey was sent in Autumn 2021 to 1854 physicians involved in outpatient treatment in Germany. A random sample of 1300 physicians were drawn from the pool of an address service and all members of the Professional Association of Physicians and Psychological Psychotherapists in Pain and Palliative Medicine in Germany (BVSD, n = 554) were contacted. A reminder was sent out in January 2022. Results: A total of 422 physicians participated in the survey, one third were primary care physicians (33%) and 65% had received additional training "specialist pain therapy". On a scale from 1 = full approval to 5 = full rejection, treatment of chronic pain by different physicians was perceived as the most important risk factor for opioid use disorder (mean (MW): 1.33, standard deviation (SD): 0.596). Further important risk factors were treatment specific. Intentional disguise by the patient (MW 1.73/SD 0.888) and opioid prescriptions by different physicians (MW 1.79/SD 0.635) were perceived as major hurdles for the identification of opioid use disorder. Regular prescription controls (MW 1.37/SD 0.648) and periodical patient contact (MW 1.49/SD 0.654) were perceived as the most important approach to reveal opioid use disorders. Discussion: The present study gives a quantification of structural and treatment-specific risk factors in the German context. This could serve as an important foundation for the development of a health policy approach to tackle these hurdles. The results indicate that fostering transparency and communication are important aspects.
Background Cognitive and perceptual treatment approaches represent an adjunctive nonpharmacological treatment option for people with chronic pain. One treatment approach is based on the graded motor imagery (GMI) theory, which integrates several cognitive-perceptual methods into a staged concept. Aim In this study, the technical and practical feasibility of a prototype for a virtual reality (VR)-based home training program incorporating key elements of GMI theory was evaluated for the first time under real-world conditions in patients with chronic unilateral pain of the upper extremities. Material and methods Patients with chronic pain used the application for 5 days per week for a maximum of 30 min over a period of 6 weeks. Technical and application-related aspects of the implementation, user acceptance and pain perception were assessed. Results A total of 13 pain patients could be included in the study, 7 patients completed the intervention and 6 discontinued prematurely, predominantly due to issues associated with the VR application. The daily training duration of 30 min was perceived as too long and the mirrored exercises were considered particularly strenuous. Pain perception changed only marginally over the course of the intervention. The technology proved to be highly error-prone. Discussion The implementation of cognitive-perceptual strategies in a VR environment as an innovative treatment approach for patients with chronic pain requires further technical and content-related optimization and will be the subject of a prospective pilot study.
Es liegen bislang keine aktuellen Zahlen zur Häufigkeit stark beeinträchtigender chronischer Schmerzen, des Gebrauchs von zentralwirksamen Schmerzmitteln sowie zu den Bezugsquellen von cannabisbasierten Arzneimitteln aus der allgemeinen deutschen Bevölkerung, vor. Personen einer Stichprobe ≥ 16 Jahre der deutschen Bevölkerung wurden im Frühjahr 2025 in einer Querschnittsstudie untersucht. Schmerzschweregrade wurden mit der deutschen Version der Graded Chronic Pain Scale Revised erfasst. 2522/6663 (38,3
