[Pain perception of adolescents with chronic functional pain : adaptation and psychometric validation of the Pain Perception Scale (SES) by Geissner]. / Schmerzempfindung bei Jugendlichen mit chronischen funktionellen Schmerzen : Adaptation und psychometrische Uberprüfung der Schmerzempfindungsskala (SES) nach Geissner.

BACKGROUND: Pain perception is a central aspect of the multidimensional model of chronic pain. Up to now, validated measurement tools are lacking in the German language for measuring pain perception in adolescents. The aim of this study was to examine and adapt the well-established Pain Perception Scale for Adults by Geissner (SES) for use in adolescents with chronic pain to provide a measure for clinical diagnosis and evaluation of treatment effects. MATERIAL AND METHODS: Principal component, reliability and item analyses were conducted on a sample with 139 adolescents. To test validity, age and sex effects, correlations with pain-related constructs, differences between treatment groups (inpatients vs outpatients) and concordance between adolescents and their parents were analysed. RESULTS: Findings support a two-factor solution with one affective and one sensory factor; three additional sensory items were included in the final version. The scales show good internal consistency. Consistent with hypotheses, we found significant correlations with pain characteristics, emotional and cognitive variables as well as pain-related disability. Inpatients and outpatients show a significant difference in affective pain perception. Concordance between parents and adolescents was high. CONCLUSION: With this questionnaire there is now a validated German assessment tool to measure pain perception in adolescents with chronic pain (Pain Perception Scale for Adolescents, SES-J). Due to its practicability it is suitable for clinical application.

[German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ). A multimodal questionnaire for diagnosis and treatment of children and adolescents suffering from chronic pain]. / Deutscher Schmerzfragebogen für Kinder, Jugendliche und deren Eltern (DSF-KJ). Entwicklung und Anwendung eines multimodalen Fragebogens zur Diagnostik und Therapie chronischer Schmerzen im Kindes- und Jugendalter.

BACKGROUND: A multidimensional assessment of chronic pain is the most important tool for diagnosis and treatment. While the German Pain Questionnaire is routinely implemented in the treatment of adults with chronic pain, similar questionnaires are scarce for children and adolescents. It was the aim of the present study to report on the development and quality of a multimodal questionnaire assessing all relevant aspects of chronic pain in children and adolescents. The quality of the questionnaire was assessed (1) by implementing the questionnaire in a sample of children and adolescents suffering from chronic pain (aged 4-18 years), (2) by analysing missing items in the child, adolescent and parent version and (3) by analysing experts' ratings of the questionnaire. MATERIAL AND METHODS: The German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ) was developed on the basis of the biopsychosocial model of chronic pain in experts' meetings. The DSF-KJ entails an assessment of sociodemographic variables, pain characteristics, triggering factors, previous pain treatment, pain-related disability and cognitive and emotional factors related to the pain experience. A total of 284 children and adolescents who presented for pain treatment in our tertiary institute completed the DSF-KJ. Eleven pain experts rated the questionnaire regarding its utility for diagnosis and treatment. RESULTS: With the use of the DSF-KJ, a detailed sample description was derived on the basis of the biopsychosocial model. More adolescent girls than boys presented to the institute. The majority of the children and adolescents suffered from headache and were severely affected by their chronic pain. Children and adolescents displayed similar pain characteristics. However, adolescents were more disabled due to chronic pain and had already undergone a variety of pain treatments. These differences may reflect an ongoing chronification in adolescents. Children, adolescents and their parents filled in the questionnaire thoroughly with very few missing items. The experts rated the questionnaire as very useful for diagnosis and treatment. CONCLUSION: The DSF-KJ provides a standardized assessment and comprehensive description of paediatric chronic pain problems and facilitates medical and psychological diagnostic and therapeutic decisions. The preliminary results suggest that the questionnaire is a clinically useful and practical assessment tool for children and adolescents with chronic pain.

[Pain-related disability in adolescents suffering from chronic pain. Preliminary examination of the Pediatric Pain Disability Index (P-PDI)]. / Schmerzbezogene Beeinträchtigung bei Jugendlichen mit chronischen Schmerzen. Erste Uberprüfung des Pediatric Pain Disability Index (P-PDI).

BACKGROUND: Pain-related disability affects many children and adolescents suffering from chronic pain and may exert an impact on all areas of their lives. Reduction of pain-related disability is, therefore, a fundamental aim of treatment; however, no validated means exist to assess pain-related disability in children and adolescents. The aim of this study was to translate the Pediatric Pain Disability Index (P-PDI) of Varni into German and to investigate its psychometric qualities. METHODS: Principal component and item analyses were conducted on outpatient (n=163) and inpatient samples (n=167) of adolescents suffering from chronic pain. Changes in pain-related disability 3 months after starting treatment were analysed in an outpatient sample of 110 adolescents. Correlations between pain-related disability, emotional variables and school absence as well as concordance with parents' ratings were investigated. RESULTS: The P-PDI is a one-dimensional assessment tool with sufficient reliability. There were significant correlations between pain-related disability and pain intensity and school absence but not with pain duration, fear and depression. Parents and adolescents ratings correlated significantly, but 57% of parents underestimated the pain-related disability of their children. CONCLUSION: There is now a validated German version of the P-PDI to measure pain-related disability in adolescents suffering from chronic pain, which can be used in studies investigating treatment effectiveness.

[Pain-related coping strategies in children and adolescents with chronic pain. Validation of a German version of the Paediatric Pain Coping Inventory (PPCI revised)]. / Schmerzbezogene Copingstrategien von Kindern und Jugendlichen mit chronischen Schmerzen. Uberprüfung einer deutschen Fassung der Paediatric Pain Coping Inventory (PPCI-revised).

Validated intruments for measuring coping in children and adolescents with chronic pain are rare in Germany. Using a sample of 180 out-patient children with chronic pain, a main component analysis was performed as well as cross-validations with out-patient and in-patient treated children. The scales of the PPCI-R showed significant relationships to pain characteristics and emotional stress. Different alterations were found in the PPCI-R scales in children with migraine and those with tension-type headache. The PPCI revised is therefore a validated instrument for measuring coping an can be implemented e.g. in treatment studies for children suffering from chronic pain.

[Assessment and measurement of pain]. / Messen und Erfassen von Schmerz.

BACKGROUND: The assessment and measurement of pain is essential in the implementation and control of pain relieving strategies. The measurement of pain in infants and children should be based on the consideration of age, cognitive level, psychological status, intercurrent diseases and the social context in order to register the child's individual situation and to avoid misinterpretation. DIAGNOSIS: In the preverbal infant, behavioral and physiological cues have to be interpreted by the caregivers. For the assessment of pain in children of four and older who have at least a basic understanding of the pain concept self assessment methods (as rating scales, specific pain interviews, diaries and questionnaires) can be used. In any case the instruments used should be age appropriate. The instruments used for the different age groups are presented with comments on quality and clinical applicability.

[Therapy of headaches in childhood and adolescence]. / Kopfschmerztherapie im Kindes- und Jugendalter.

BACKGROUND: Headaches are one of the most common health problems of children and adolescents, afflicting between 50-90% of the pediatric population in some form sometimes during their first two decades of life. Due to changing prevalence rates, more or less complex classification systems, inconsistent therapy responses with great inter- and intraindividual variabilities and high placebo response rates, pediatric headache syndromes are frequently thought to be too difficult for the outpatient evaluation and treatment in clinical practice. THERAPY AND PROGNOSIS: However, with the introduction of the International Headache Society classification system, the continuously expanding knowledge about the pathophysiology of different headache syndromes and the development of new symptomatic as well as causative treatment options - covering both: pharmacologic and non-pharmacologic approaches - a pragmatic diagnostic work up and the development of specific treatment schedules for pediatric headache patients is now possible.

[Quality assurance in chronic pain therapy. Results obtained by a task force of the German Chapter of the International Association for the Study of Pain on psychological Assessment of chronic Pain. Psychological instruments for the assessment of pediatric pain]. / Qualitätssicherung in der Therapie chronischen Schmerzes. X. Instrumente zur Erfassung von Schmerz bei Kindern.

The present paper is one in a series of publications reviewing German instruments for the psychological assessment of pain. Part X deals with pain measurement of acute and chronic pain in infants and children. German assessment instruments of pediatric pain together with frequently used instruments of American origin are examined and described. The survey contains self-report and behavioral pain measures. Multidimensional pain interviews for both children and parents, diaries and rating scales, as well as observation measures especially for infants, are examined. Since the selection of pain-assessment instruments is dependent on the age and cognitive level of the children, for each instrument a minimum age limit is given. In cases in which quantitative indices of reliability, validity and objectivity are still needed, the evaluation is based on qualitative quotations.

[Quality control in the therapy of chronic pain. Results obtained by a task force of the German Section of the International Association for the Study of Pain on psychological assessment of chronic pain. XI. Assessment and multiaxial classification of pain]. / Qualitätssicherung in der Therapie chronischen Schmerzes. XI. Diagnostik und multiaxiale Schmerzklassifikation.

This paper reviews instruments in German language for the psychological assessment and classification of pain. Usually chronic pain syndromes are classified within the International Classification of Diseases (ICD). Instead of the psychiatric chapter of the ICD, it is possible to use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The proposed classification system of the International Association of the Study of Pain (IASP) is based on a multiaxial solution. The numerous ways to classify chronic pain include many problems and limits, especially in the case of an interdisciplinary assessment. They provide no specific system for classifying pain syndromes. They are impractical to handle and restrict classifying pain as either somatogenic or psychogenic. It is not possible to describe both sides in one diagnosis without loss of information. As a result of this situation, a task force of the German Chapter of the International Association for the Study of Pain developed a Multiaxial Classification of Pain (Multiaxiale Schmerzklassifikation; MASK) as an advanced system of pain assessment and an alternative to the common classification systems. MASK embraces a somatic (MASK-S) and a psychological (MASK-P) part. Both parts constitute an 'interdisciplinary diagnosis'. MASK-S enables classifying a pain syndrome using hierarchical levels, with progredient specific degrees of differentiation. In addition there are 6 axes to describe pain syndromes qualitatively and quantitatively (e.g. localization, quality). The psychosocial part (MASK-P) embraces 5 main levels (1. behavioral, 2. emotional, 3. cognitive, 4. stress-related, 5. habitual personal factors) and 2 additional levels (6. functional coherence, 7. ICD/DSM-diagnosis additional). The MASK-P part of the diagnosis is composed of graduation on these levels. Differential axis of the pain syndromes are described phenomenologically and specifically. MASK provides the possibility of establishing an integrative, interdisciplinary diagnosis.

[Quality assurance in therapy of chronic pain. Results obtained by a task force of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain. IX. Multidimensional instruments for the assessment of aspects relating to pain and recommendations on standard procedures for diagnosis]. / Qualitätssicherung in der Therapie chronischen Schmerzes. Ergebnisse einer Arbeitsgruppe der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) zur psychologischen Diagnostik. IX. Multidimensionale Verfahren zur Erfassung schmerzrelevanter Aspekte und Empfehlungen zur Standarddiagnostik.

Four multidimensional inventories used as instruments for the assessment of pain are examined: "Fragebogen zur Erfassung der Schmerzverarbeitung' [Questionnaire for Assessment of Level of Coping with Pain], "Kieler Schmerzverarbeitungs-Inventar' [Kiel Inventory of Coping with Pain], "Fragebogen zur Schmerzregulation' [Questionnaire on Pain Regulation], and the German version of the "Multidimensional Pain Inventory'. None of these questionnaires assesses all domains that are important in chronic pain. The recommended standardized assessment routine for pain centres includes the use of a diary, the rating of actual, average and maximum pain intensity, the application of the PDI, a measure of disability, and the FESV, which records cognitive processing and coping. As measures of general psychological dysfunction the ADS for the assessment of depression and the B-L, a symptom checklist, are suggested as instruments suitable for routine use in diagnosis and evaluation.

[Quality assurance in therapy of chronic pain. Results obtained by a taskforce of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain. VIII. Instruments for the assessment of pain-associated dimensions: depression, somatic symptoms, anxiety.]. / Qualitätssicherung in der Therapie chronischen Schmerzes : Ergebnisse einer Arbeitsgruppe der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) zur psychologischen Diagnostik VIII. Verfahren zur Erfassung schmerzassoziierter Dimensionen: Depressivität, Beschwerden, Angst.

Chronic pain is often associated with an array of general psychological dimensions such as depression, somatic symptoms, anxiety, anger and a loss of quality of life. Part VIII describes various instruments concerning each dimension and comments on their applicability within a diagnostic routine for chronic pain patients. TheAllgemeine Depressionsskala (German version of CES-D) is recommended for the assessment of depression, and theBeschwerden-Liste seems best for assessing somatic symptoms. Trait-anxiety and pain-unrelated state-anxiety seem not to be suitable because they lack significance for the therapy process. While the inventory for assessing anger still needs an empirical basis for chronic pain patients, quality of life inventories are not recommended for routine pain assessment.

[Quality assurance in therapy of chronic pain. Results obtained by a taskforce of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain : VI. Instruments for the assessment of disability VII. Psychological instruments for the assessment of pain relevant aspects of social interaction and communication.]. / Qualitätssicherung in der Therapie chronischen Schmerzes Ergebnisse einer Arbeitsgruppe der DGSS zur psychologischen Diagnostik : VI. Verfahren zur Erfassung von Behinderung/Beeinträchtigung VII. Verfahren zur Erfassung schmerzrelevanter interaktioneller Aspekte in Familie und Partnerschaft.

Disability is a central aspect in the assessment of chronic pain patients. Disability questionnaires in German (developed or adapted) are examined and selected for different purposes. The "Funktionsfragebogen Hannover" and the "Pain Disability Index" are recommended for both research and clinicalapplication while the "Sickness Impact Profile" is suitable only for research purposes.Four different German questionnaires for the assessment of social interaction and communication in pain patients and their significant others are examined in part VII. There are some empirical data for three of them. Only the "Inventory of Familial Adaptability and Cohesion" has achieved a certain degree of empirical maturity. Further research and developmental activity in this area of pain assessment are urgently needed.

[Quality assurance in therapy of chronic pain. Results obtained by a taskforce of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain. V. Instruments for the assessment of pain-related cognitions and coping with pain.]. / Qualitätssicherung in der Therapie chronischen Schmerzes : Ergebnisse einer Arbeitsgruppe der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) zur psychologischen diagnostik V. verfahren zur Erfassung kognitiver Schmerzverarbeitung (Schmerzkognitionen) und Schmerzbewältigung (Coping).

The present paper is one of a series of publications, reviewing German instruments for psychological assessment of pain. Their main focus is on the results of a task force on quality testing for each subject. This paper describes and comments on methods regarding self-reporting of pain cognitions and both cognitive and behavioral strategies for coping with pain. Concerning pain cognitions one focus is on patients' attributions of causes of pain and the modes of controlling pain (subjective pain model). The other focus is on instruments recording "pain beliefs" in the sense of dysfunctional congitions associated with the experience of pain. Each instrument was examined with reference to approved psychometric criteria, empirical foundation and clinical relevance. It was noted that several instruments are deficient in their psychometric criteria and their empirical foundations. We used these data as a basis to elaborate a specific and differential recommendation. A similar procedure was followed with instruments for the assessment of pain-related coping strategies. According to our research there are two subgroups of coping instruments, one more specifically for cognitive coping with pain, and the other combined with behavioral coping strategies. Once again, we elaborated a specific and differential recommendation, giving priority to instruments taking account of both cognitive and behavioral dimensions of coping with pain.

[Quality assurance in therapy of chronic pain. Results obtained by a taskforce of the German Section of the Association for the study of Pain psychological assessment of chronic pain. Instruments for the assessment of pain experience and pain behaviour.]. / Qualitätssicherung in der Therapie chronischen Schmerzes Ergebnisse einer Arbeitsgruppe der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) zur psychologischen Diagnostik : II. Verfahren zur Erfassung des Schmerzerlebens III. Verfahren zur Erfassung des Schmerzverhaltens IV. Verfahren zur Erfassung der Schmerzintensität und Schmerztagebücher.

The series of publications is continued in which the results of a review of German pain-related psychological assessment tools are presented. The taskforce of the German Society for the Study of Pain (DGSS) describes and examines instruments assessing the qualitative aspects of how pain is experienced (part II). Part III describes and comments on methods regarding self-reporting and observation of pain behaviour. Part IV discusses the use of pain diaries and introduces different forms of diaries, focussing on the measurement of pain intensity.

[Quality assurance in therapy of chronic pain. Results obtained by a taskforce of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain.]. / Qualitätssicherung in der Therapie chronischen Schmerzes : Ergebnisse einer Arbeitsgruppe der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) I. Einführung und Uberblick.

This is the first in a series of publications presenting the results of a taskforce on quality assurance in psychological assessment of chronic pain. The initiative was motivated by the increasing and confusing variety of newly developed German instruments and/or translations of Anglo-American instruments. Our main work was therefore concentrated on the collection of existing German assessment instruments, on summarizing the essentials in a documentary sheet, and on examining their objectivity, reliability, validity, clinical relevance, economy and degree of empirical foundation. For each diagnostic domain we thus elaborated specific differential recommendations for those working in psychological pain research and clinical practice, in an attempt to devise criteria enabling them to choose the optimal instrument or test battery for their needs and conditions.

Esophageal carcinoma: prognostic features and comparison between blunt transhiatal dissection and transthoracic resection.

Among 86 patients who underwent resection for thoracic esophageal carcinoma between 1982 and 1989, 49 were resected by a transhiatal blunt esophagectomy (THE) and 37 underwent a transthoracic-abdominal esophagectomy (TTE). The two groups were statistically comparable with respect to preoperative characteristics. Overall morbidity and respiratory complications were high for both groups (71% vs 62% and 45% vs 46%; P = NS). The rate of cardiac, renal, neurological and bleeding complications, as well as recurrent nerve injuries was similar in both groups. An anastomotic leak occurred in 39% (19/49) of THE patients and in 11% (4/37) (P < 0.05) of TTE patients. Hospital mortality was 16% (8/49) in the THE group (4 resulting from cervical anastomotic leaks, 4 from respiratory complications) and 13% (5/37) in the TTE patients (1 from myocardial infarction, 4 from respiratory failures; P = NS). Actuarial survival curves for all THE and TTE patients (5-year survival rate: 20% vs 22%) and separate analysis for N0 and N1 tumors revealed no significant difference between these two techniques. Of the different preoperative variables, only tobacco addiction, beside lymph node involvement, was an independent predictor of outcome. Respiratory complications and hospital mortality were significantly lower for the non-smokers and long term survival was significantly higher for the N0 stages.

[Anus praeter--site, care and corrective possibilities]. / Anus praeter--Sitz, Pflege und Korrekturmöglichkeiten.

BASIC REMARKS: The main indication for an colostomy is a carcinoma low down in the rectum. Apart from this, tumors in any part of the bowel or neighboring organs, and complications of inflammatory disease may make a diversion of feces necessary. POINTS DISCUSSED: A stoma should be sited at a distance from skin folds, and bony protuberance, and should be readily visible for self-care. Temporary "continence" can be achieved with special stool regulatory measures (in particular irrigation), while the patient can make to with a stoma cap or a mini-bag. Many complications of stoma, in particular necrosis, parastomal hernias, prolapse, too large a stoma, stenosis and stomal recurrent tumor can usually be eliminated by surgery. CONCLUSIONS: Today excellent possibilities of stomal care are available for a wide range of problems, which can be determined and applied in cooperation with the various specialists.

Presence of atrial natriuretic factor prohormone in enterochromaffin cells of the human large intestine.

Atrial natriuretic factor is a hormone intimately involved in water and salt homeostasis. The heart constitutes the major but not exclusive site of synthesis of this hormone. Among other functions, the gastrointestinal tract has endocrine functions, plays an important role in volume regulation of the body, and seems to be a target organ for atrial natriuretic factor. Therefore, the presence of atrial natriuretic factor was investigated in the human gut. Immunoreactive atrial natriuretic factor was found in intraoperatively obtained samples of normal human colon. Acidic extracts of human large intestine contained about 0.4 pmol/g wet wt of atrial natriuretic factor. Analysis of atrial natriuretic factor immunoreactivity by gel-filtration and reverse-phase high-performance liquid chromatography showed that about 65% of the immunoreactivity corresponded to the atrial natriuretic factor phohormone and about 35% corresponded to the C-terminal ANF99-126. Immunohistochemistry showed atrial natriuretic factor prohormone location in enterochromaffin cells of the colon mucosa. Altogether, these findings show the presence of atrial natriuretic factor prohormone in enterochromaffin cells of the human large intestine and may suggest this organ as a site of atrial natriuretic factor synthesis in humans.

[Carcinoid tumor of the stomach--aspects of surgical therapy]. / Das Carcinoid des Magens--Aspekte zur chirurgischen Therapie.

Carcinoid tumors of the stomach are rare (0.4% of all malignancies of the stomach). Long-lasting hypergastrinemia, most often due to chronic atrophic gastritis, leads to hyperplasia of ECL-cells in the gastric fundic mucosa with consequent dysplasia or neoplasia. Between 1974 and 1988 four patients underwent surgical treatment after diagnosis of a gastric carcinoid tumor. One patient was treated by local excision, two by subtotal resection and one patient underwent complete gastrectomy. None of the patients had local or distant metastases or died in the follow-up period due to tumor progression. The different approaches to surgical therapy are discussed.