[Characteristic values and test statistical goodness of the Veterans RAND 12-Item Health Survey (VR-12) in patients with chronic pain : An evaluation based on the KEDOQ pain dataset]. / Kennwerte und teststatistische Güte des Veterans RAND 12-Item Health Survey (VR-12) bei Patienten mit chronischem Schmerz : Eine Auswertung auf Basis des KEDOQ-Schmerz-Datensatzes.

The Veterans RAND 12-Item Health Survey (VR-12) was added to the German Pain Questionnaire (DSF) as a self-report measure of health-related quality of life in 2016, replacing the previously used SF-12, which required a license. Both measures have 12 items and include a physical component summary (PCS) and a mental component summary (MCS). Evaluations with a larger sample on characteristic values and on the test-statistical goodness of the VR-12 in patients with chronic pain are so far missing. Data on the VR-12 and other procedures of the DSF were evaluated from 11,644 patients from 31 centers participating in KEDOQ pain. The patients filled out the DSF before starting a pain therapy treatment. Change sensitivity was determined for 565 patients for whom the VR-12 was available from a follow-up questionnaire of the DSF several months after the initial survey.The reliability (Cronbach's alpha) of the PCS was rtt = 0.78 and for the MCS rtt = 0.84. The MCS had significant relationships with the depression, anxiety and stress scales (r = -0.51 to r = -0.72), and the PCS correlated more highly with areas of pain-related impairment (r = -0.48 to r = -0.52). Patients with higher pain chronicity, those with higher pain severity, and those with evidence of high psychological distress described significantly lower health-related quality of life in PCS and MCS. The effect size (ES) of change in terms of improvement in health-related quality of life was ES = 0.33 in the MCS and ES = 0.51 in the PCS.The results are in agreement with the findings of the SF-36 and SF-12 in patient collectives with chronic pain. In summary, they show that the VR-12 is an adequate substitute for the SF-12 in the German pain questionnaire.

[The anesthesiological questionnaire for patients in the outpatient context : Investigations on patient state of health after outpatient operations using the anesthesiological questionnaire for patients]. / Der Anästhesiologische Nachbefragungsbogen für Patienten im ambulanten Kontext : Untersuchungen zum Patientenbefinden nach ambulanten Operationen mithilfe des Anästhesiologischen Nachbefragungsbogen für Patienten.

BACKGROUND: The evaluation of German postanesthesia questionnaires is often restricted to inpatient medical care. The anesthesiological questionnaire for patients (ANP) has previously been validated only after medical care of inpatients. Therefore, the aim of the present study was to evaluate the validity of the ANP in the context of outpatient surgery and anesthesia. METHODS: Data from 4547 patients (mean age 18-89 years, sex: m/f, 55%/45%), scheduled for ambulatory orthopedic and trauma surgery, were analyzed. All patients received a standard induction of anesthesia with propofol, sufentanil and 4 mg dexamethasone. Maintenance of anesthesia was achieved with a balanced technique comprising volatile anesthesia (either sevoflurane or desflurane) and sufentanil. In addition, patients undergoing operations on the anterior cruciate ligament received a femoral nerve block with 12-15 ml 0.5% ropivacaine. Of the patients 13% remained in hospital overnight as a result of complex operations (combined anterior and posterior cruciate ligament repair, hip arthroscopy and 10% of those undergoing shoulder operations). Before discharge from the recovery room, patients were asked to answer questions with respect to postoperative symptoms 1h after anesthesia (ESNA 19 items), at the time of interview (ABZ 17 items) and about overall patient satisfaction (10 items). These results were matched with the type of procedure and time data from the patient administration system. All data were analyzed descriptively using parametrical tests. RESULTS: At both time points, pain in the area of the operation was the predominant symptom (ESNA: 77,1%; ABZ: 74,3%). Pain after shoulder arthroscopy was more severe compared to knee arthroscopy, both with and without repair of the anterior cruciate ligament. Most of the adverse symptoms decreased significantly (p ≤ 0.001) with time, demonstrating progressive recovery of the patient. Patient discomfort was more likely to occur in female than in male patients, and female patients were more likely to be dissatisfied with the progress of recovery. The risk of experiencing adverse symptoms after anesthesia was higher for female than for male patients; this was most apparent for feeling cold (odds ratio, OR 4.08) and nausea and vomiting (OR 3.45). Younger patients (18-40 years) were more likely to express discomfort than both groups of older patients (41-60 years and 61-89 years). Accordingly, younger patients had lower satisfaction levels with respect to both anesthesia and overall perioperative care, and the progress of recovery. Postoperative nausea and vomiting (PONV) were linked to younger age, female sex, and longer procedure times (>40 min). CONCLUSION: The individual analyses delivered plausible results, which support the validity of the ANP. The ANP may also be used for assessment of postoperative discomfort and patient satisfaction in the setting of outpatient surgery. In view of the short time interval between the two measurement points, the ANP for outpatients could in future be reduced to a single postoperative questionnaire.

[Stressors for patients in the intensive care unit : An analysis taking controllability into consideration]. / Belastungen für Patienten auf der Intensivstation : Eine Analyse unter Berücksichtigung der Kontrollierbarkeit.

OBJECTIVE: Studies on stress factors for patients in intensive care units (ICU) have so far concentrated on whether certain stressors have occurred or how stressful they were. There are no studies on stress for patients in ICUs that measured both the perception of stress and the chances perceived to control it; however, loss of control can result in long-term psychopathological consequences, such as depression or posttraumatic stress disorder. Therefore, a questionnaire was developed to evaluate the influence of controllability on perception of stress. The aim of this study was to answer the following questions: which situations were experienced as stressful by patients in ICUs, whether patients perceived them as being controllable and whether the experience of stress depended on the controllability? Furthermore, it was examined which stressful situations are specific to ICUs. MATERIAL AND METHODS: The questionnaire included 18 potentially stressful situations for ICU patients. These situations were assessed with respect to the occurrence, frequency and duration, the impact of stress and the perception of control. In addition, anxiety was assessed using STAI-X1. A total of 198 ICU patients and 100 patients hospitalized in a general surgery ward were interviewed. RESULTS: Patients in ICUs remembered significantly more stressful situations than those on the normal ward (M ± SD = 10.2 ± 2.7 vs. 6.6 ± 2.0; d = 1.48; p < 0.001) and perceived them as more stressful (mean stress: M ± SD = 3.6 ± 1.5 vs. 2.2 ± 1.3; d = 1.01; p < 0.001). The most stressful situations for ICU patients were fixation of the arms (M ± SD = 7.47 ± 3.27), mechanical ventilation (M ± SD = 7.36 ± 3.29) and endotracheal suctioning (M ± SD = 7.19 ± 2.99). Approximately one third of patients underwent these situations. Situations experienced by more than 90% of ICU patients were evaluated as being the least stressful experiences, including infusion (M ± SD = 2.7 ± 2.7), measuring heart activity (M ± SD = 2.3 ± 2.7), taking blood samples (M ± SD = 2.2 ± 2.7), and temperature control (M ± SD = 0.9 ± 1.7). Controllability experienced by ICU patients negatively correlated with anxiety (r = -0.20, p = 0.004) and mean sensation of stress (r = -0.36; p < 0.001). When comparing stress levels of ICU patients who perceived controllability in a given situation to those who did not, the greatest effects (Cohen's d > 1.4) were observed for the situations presence of a bed barrier (M ± SD = 0.1 ± 0.4 vs. 5.9 ± 2.8), lighting at night (M ± SD = 0.7 ± 1.7 vs. 5.7 ± 3.3), presence of a ventilation tube (M ± SD = 2.5 ± 2.1 vs. 6.7 ± 3.0) and repositioning of the patient (M ± SD = 2.5 ± 2.9 vs. 6.7 ± 2.9). CONCLUSION: The experience of loss of control seems to negatively modify the impact of stressors. Thus, an increase in aspects of controllability could reduce the burden on patients during intensive care.

[Pain therapy care in Germany-Do patients receiving day care differ from those receiving outpatient or inpatient care at the start of treatment? : A further evaluation based on the KEDOQ-pain data set]. / Schmerztherapeutische Versorgung in Deutschland ­ unterscheiden sich teilstationär versorgte Patienten von den ambulant oder stationär versorgten bei Behandlungsbeginn? : Eine weitere Auswertung auf Basis des KEDOQ-Schmerz-Datensatzes.

The direct comparison of day care pain patients with patients from other treatment sectors with respect to sociodemographic, pain-related and psychological characteristics has not yet been the subject of systematic analyses. The project core documentation and quality assurance in pain therapy (KEDOQ-pain) of the German Pain Society (Deutsche Schmerzgesellschaft e.V.) makes this comparison possible. This second analysis of the available KEDOQ data was intended to show how patients receiving day care treatment can be characterized using the core data set and whether and to what extent they differ from patients receiving outpatient or inpatient treatment. This is a continuation of the first publication, which showed remarkably small differences between outpatients and inpatients but did not include day care patients.The KEDOQ-pain data from 25 centers with a total of 8953 patients were evaluated. Patients had completed the German pain questionnaire (DSF) between January 2012 and March 2017 and received day care (n = 1264), outpatient (n = 4082) or inpatient (n = 3607) pain therapy treatment. Sociodemographic, pain-related and psychometric data of the DSF reported by patients were evaluated as well as physician information on the pain chronification stage and pain localization. The evaluation was descriptive and compared groups using univariate and multivariate procedures.Day care treated patients were significantly younger, had a higher level of education, were more frequently employed, reported higher impairment values and showed a higher severity index according to von Korff than inpatients and outpatients treated for pain. In addition, they described a shorter pain duration as well as worse habitual well-being (Marburg questionnaire on habitual well-being, MFHW). These predictors explained roughly half of the variance in the prediction of the day care treatment setting. The comparison of outpatients and inpatients showed significant group differences for some variables; however, the effects were very small.The evaluations suggest that pain therapy day care facilities treat a special group of pain patients that significantly differ from patients in other treatment sectors. Cautious conclusions are drawn regarding the systematic allocation of patients to care appropriate to their treatment needs.

[Management of patients with chronic pain in acute and perioperative medicine : An interdisciplinary challenge]. / Management von Patienten mit chronischen Schmerzen in der Akut- und perioperativen Medizin : Eine interdisziplinäre Herausforderung.

Chronic pain is a frequent comorbidity of patients in hospitals and has an influence on the clinical course and the duration of hospitalization. There is a need to have a better understanding of chronic pain as a comorbidity and it should be considered to a greater extent in understanding diseases, in treatment concepts and hospital structures to ensure a resource-oriented and high-quality care. This begins on admission by identifying pre-existing pain and related risk factors with the medical history and taking these into account in the treatment regimen. A multimodal treatment approach that involves medicinal, educational, psychological and physiotherapeutic expertise is required in these patients. A unimodal approach in the treatment is not effective. A pain physician should be involved in the treatment team as early as possible. Furthermore, psychological joint supervision should be available for these patients as several studies have demonstrated positive perioperative effects of psychological approaches on the treatment in this patient group.

[High pain expectation and impairment from pre-existing pain are risk factors for severe postoperative pain : Results of a study using the Lübeck Pain Risk Questionnaire]. / Hohe Schmerzerwartung und Beeinträchtigung durch vorbestehende Schmerzen sind Risikofaktoren für hohe postoperative Schmerzen : Ergebnisse einer Untersuchung mit dem Lübecker "Schmerzrisiko-Fragebogen".

BACKGROUND: The intensity of postoperative pain is characterized by large interindividual variability. Furthermore, strong postoperative pain is known to influence physical recovery after surgery. High (preoperative) pain expectation and pre-existing pain, which are associated with pain-related disability (impairing pain) are risk factors for strong postoperative pain. They can be determined with the Lübeck Pain Risk Questionnaire used for the first time in this study. The aim of this study was to explore the hypothesis that patients with a combination of the characteristics (1) preoperative impairing pain and (2) high pain expectation are more likely to have strong postoperative pain. Patients with these characteristics represent a unique group of patients and are more likely to develop distinct postoperative pain and can therefore be characterized as a risk group. MATERIAL AND METHODS: A total of 501 patients at the departments of general surgery, plastic surgery, trauma surgery and orthopedic surgery of the UKSH Campus Lübeck were included in this study. All underwent elective surgery. Study patients were 18 years and older. Those needing postoperative treatment in an intensive care unit were excluded from this study (n = 18). The characteristics "preoperative pain" and "pain expectation" were measured with the Lübeck Pain Risk Questionnaire the day before surgery. The primary outcome variable was the average postoperative pain intensity, which was measured with a numeric rating scale (NRS 0-10) and scores > 4 were defined as severe pain. RESULTS: The NRS range for "preoperative pain" was subdivided as follows: "no pain" (NRS = 0), "functional pain" (NRS = 1-3), and "impairing pain" (NRS = 4-10); that for "pain expectation" as: "low expectation" (NRS = 0-4) and "high expectation" (NRS = 5-10). To determine these cut-off points, they were varied from > 1 to > 8 and those with highest effect size for strong postoperative pain were chosen. Patients with a high pain expectation had significantly stronger postoperative pain (p < 0.001) and significantly more often higher pain intensity than patients with a low expectation (53.3% vs. 20.6%, respectively, p < 0.001). Patients with pre-existing impairing pain had significantly stronger and more frequently higher postoperative pain than patients with pre-existing functional pain (43.4% vs. 18.4%, p < 0.05). Patients with a combination of the factors "preoperative impairing pain" and "high pain expectation" showed distinct postoperative pain with NRS > 4 significantly more often (59.4%, p < 0.001). These findings could be demonstrated for the departments general surgery, plastic surgery and trauma surgery. CONCLUSION: The combination of both risk factors results in a unique risk group for the appearance of strong postoperative pain. This group can be economically determined in the daily clinical routine using the Lübeck Pain Risk Questionnaire. Further studies must be carried out to show if additional perioperative procedures can be profitable for the risk group identified with the Lübeck Pain Risk Questionnaire; however, patients falling outside the risk group must not be neglected because they too can develop severe postoperative pain.

[Pain therapy in Germany - what is the difference between initial outpatient and inpatient treatment? : Assessment based on the KEDOQ pain dataset]. / Schmerztherapeutische Versorgung in Deutschland ­ was unterscheidet ambulante und stationäre Patienten zu Behandlungsbeginn? : Eine Auswertung auf Basis des KEDOQ-Schmerz-Datensatzes.

A comparison of chronic pain patients in outpatient and inpatient treatment settings regarding pain-related and psychological characteristics, has not yet been systematically analyzed. The core documentation and quality assurance in pain therapy (KEDOQ-Schmerz) is a quality assurance system for documentation and quality management of pain therapy in different treatment settings. The system was initiated by the German Pain Society. We used KEDOQ-Schmerz data to describe differences between patients being treated in outpatient and inpatient settings with respect to social, pain-related and psychological factors. In total, the set of KEDOQ-Schmerz data analyzed included information from 4705 patients (from 13 clinics) collected between January 2012 and April 2016. Patients received either outpatient (n = 2682) or inpatient (n = 2023) treatment. The data analyzed comprised sociodemographic, pain-related and psychological data collected through the German Pain Questionnaire (DSF) at the beginning of treatment as well as information about pain chronification and pain localization provided by practitioners. The statistical analysis was carried out by descriptive and comparative data analysis using univariate and multivariate statistical methods. Patients with inpatient treatment were significantly older, more often female and more often had multiple pain localizations. They described stronger pain intensity and more frequently had a higher Mainz Pain Staging System (MPSS) score of pain chronification. They described a significantly poorer physical and mental health-related quality of life in the short form (SF-12) health survey, had significantly higher depression, anxiety and stress values (DASS) and a poorer habitual well-being in the Marburg questionnaire on habitual well-being (MFHW). Significant group differences had only small effect sizes. Even though most predictors for the inpatient treatment setting in multivariate analysis were significant, in total they explained less than 5% of the variance. The results indicate that pain therapy in specialized pain settings more and more has to manage patients with higher pain chronification, higher pain-related stress and previous therapy experience. The differences in patient characteristics between treatment settings are mostly clinically unimportant. Differences in clinical features do not declare the allocation to one treatment setting or the other.

[Recommendations of the updated LONTS guidelines. Long-term opioid therapy for chronic noncancer pain]. / Empfehlungen der aktualisierten Leitlinie LONTS. Langzeitanwendung von Opioiden bei chronischen nicht-tumorbedingten Schmerzen.

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. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of the recommendations was established by multistep formal procedures, in order to reach a consensus according to German Association of the Medical Scientific Societies ("Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften", AWMF) regulations. The guidelines were reviewed by the Drug Commission of the German Medical Association, the Austrian Pain Society and the Swiss Association for the Study of Pain. RESULTS: Opioids are one drug-based treatment option for short- (4-12 weeks), intermediate- (13-25 weeks) and long-term (≥ 26 weeks) therapy of chronic osteoarthritis, diabetic polyneuropathy, postherpetic neuralgia and low back pain. Contraindications are primary headaches, as well as functional somatic syndromes and mental disorders with the (cardinal) symptom pain. For all other clinical presentations, a short- and long-term therapy with opioid-containing analgesics should be evaluated on an individual basis. Long-term therapy with opioid-containing analgesics is associated with relevant risks (sexual disorders, increased mortality). CONCLUSION: Responsible application of opioid-containing analgesics requires consideration of possible indications and contraindications, as well as regular assessment of efficacy and adverse effects. Neither an uncritical increase in opioid application, nor the global rejection of opioid-containing analgesics is justified in patients with CNCP.

[Self-rated pain sensitivity and postoperative pain]. / Selbstbeurteilte Schmerzempfindlichkeit und postoperativer Schmerz.

OBJECTIVES: Pain sensitivity is a risk factor for postoperative pain and is usually determined by experimental pain stimulation. Ruscheweyh et al. (Pain 146:65-74, 2009) developed the pain sensitivity questionnaire (PSQ) which assesses general pain sensitivity by self-rating without using extensive and painful experimental stimulation. The objective of this study was to examine whether subjective pain sensitivity affects postoperative pain intensity and can be considered as a risk factor for postoperative pain. MATERIALS AND METHODS: After obtaining informed consent 162 patients were enrolled in the study. Subjective pain sensitivity was assessed prior to surgery by using the PSQ. With respect to the results patients were classified into one of three groups (low, medium and high pain sensitivity). Primary outcome was postoperative pain intensity measured by numerical rating scales (NRS) on the first and second days after surgery. Other variables concerned administration of analgesics and patient satisfaction. The psychological control variables stress coping (SVF-48) as well as depression and anxiety (HADS-D) were also examined using the appropriate questionnaire. RESULTS: Patients with high pain sensitivity reported significantly higher postoperative pain than patients with low pain sensitivity. This result remained significant considering negative coping styles as a covariate. Patients with high pain sensitivity reported a stronger increase of pain intensity from resting in bed to moving in bed (effect size= 1.17) as compared to patients with low pain sensitivity (effect size= 0.77). Stronger pain (NRS > 4) was reported significantly more often by patients with high pain sensitivity. Furthermore, the patient group with low pain sensitivity reported the highest satisfaction with their own health recovery. CONCLUSIONS: Subjective pain sensitivity can easily be measured by the PSQ and is a risk factor for postoperative pain intensity.

[Postoperative complaints : gender differences in expectations, prevalence and appraisal]. / Postoperative Beschwerden : Geschlechtsunterschiede in Erwartung, Auftreten und Bewertung.

OBJECTIVE: Women report more severe postoperative complaints than men (e.g. nausea and pain) and expectations of complaints prior to surgery influence the postoperative complaints. Therefore, the aim of this study was to explore if gender differences in complaint expectation can account for differences in postoperative complaints. A further objective was to investigate the effective load of complaints and to look for gender differences. METHODS: In total 281 patients (128 men and 153 women) were included in the study and all patients underwent elective general surgery. Patients were asked for symptom expectations and symptom experiences prior to surgery. After surgery they answered the Anesthesiological Questionnaire (ANP) a validated self-rating method for the assessment of postoperative symptoms and complaints. The symptoms referred to in the questionnaire included sensation of cold, sensation of heat, nausea and vomiting, tickly throat, croakiness, dry mouth and thirst, difficulty in breathing, sore throat, pain in the area of surgery, pain in the area of infusion, muscle pain, back pain, headache, difficulties in urination, difficulty in awakening and feeling of somatic discomfort. In addition patients rated the affective load of the postoperative complaints. RESULTS: In previous surgery women reported experiencing more postoperative somatic complaints than men. Sex-related differences were significant (p < 0.05) for sensation of cold, nausea and vomiting, tickly throat, croakiness, sore throat, pain and the feeling of somatic discomfort. Likewise, women expected more intensive postoperative complaints following the forthcoming operation. After surgery women reported significantly more severe complaints in negative symptoms of the ANP (e.g. nausea and vomiting, pain and somatic discomfort). Effect sizes of sex-related differences varied according to the symptom (e.g. for pain effect strength d = 0.50, for nausea d = 0.60 and for thirst d = 0.13). Effect sizes decreased when the effect of expectation was statistically controlled. Logistic regression revealed that expectation was an independent predictor for the sensation of severe nausea (odds ratio OR 4.3] and intensive postoperative pain (OR 2.6). Regardless of gender, postoperative pain, nausea and dry mouth/thirst were symptoms with the highest affective load. CONCLUSIONS: Preoperative expectations increase gender differences in somatic complaints following surgery. Anesthesiological education of patients should influence dysfunctional expectations. Postoperative pain, nausea and thirst should be the main targets of interventions to improve patient complaints.

[German pain questionnaire and standardised documentation with the KEDOQ-Schmerz. A way for quality management in pain therapy]. / Deutscher Schmerzfragebogen (DSF) und standardisierte Dokumentation mit KEDOQ-Schmerz. Auf dem Weg zur gemeinsamen Qualitätsentwicklung der Schmerztherapie.

KEDOQ-Schmerz was developed by the German Pain Society (formerly DGSS) as a basic tool for documentation and quality management of pain therapy. It is planned to use KEDOQ-Schmerz as the data basis for nationwide, cross-sectional and independent scientific research in health services in Germany. With comparatively little effort, each participating institution (practices, pain clinics) will be able to provide quality control of their own diagnostic procedures and therapeutic effects by using benchmarking. In future KEDOQ-Schmerz will also be used as a method for external quality management in pain therapy in Germany.

[Epidural spinal cord stimulation for therapy of chronic pain. Summary of the S3 guidelines]. / Epidurale Rückenmarkstimulation zur Therapie chronischer Schmerzen. Zusammenfassung der S3-Leitlinie.

Epidural spinal cord stimulation (SCS) is a reversible but invasive procedure which should be used for neuropathic pain, e.g. complex regional pain syndrome I (CRPS) and for mostly chronic radiculopathy in connection with failed back surgery syndrome following unsuccessful conservative therapy. Epidural SCS can also successfully be used after exclusion of curative procedures and conservative therapy attempts for vascular-linked pain, such as in peripheral arterial occlusive disease stages II and III according to Fontaine and refractory angina pectoris. Clinical practice has shown which clinical symptoms cannot be successfully treated by epidural SCS, e.g. pain in complete paraplegia syndrome or atrophy/injury of the sensory pathways of the spinal cord or cancer pain. A decisive factor is a critical patient selection as well as the diagnosis. Epidural SCS should always be used within an interdisciplinary multimodal therapy concept. Implementation should only be carried out in experienced therapy centers which are in a position to deal with potential complications.

[Success of treatment in higher stages of pain chronification as well? An evaluation of the Mainz pain staging system based on the QUAST-analysis sample]. / Behandlungserfolg auch bei höherer Schmerzchronifizierung? Eine Auswertung des Mainzer Stadienmodells auf Basis der QUAST-Analysestichprobe.

BACKGROUND: More than 10 years ago Gerbershagen gave a pessimistic prognosis for treatment success in patients with higher stages of pain chronification. To date only few studies concerning this statement exist and the results are inconsistent. The objective of this study was to evaluate the prognostic validity of the Mainz pain staging system (MPSS) in a large multicenter sample. It was assessed whether effects of treatment in patients with higher stages of pain chronification are less than those in other patients. Of further interest was whether treatment success is related to different outcome measures. METHODS: A total of 1,461 patients with the pain syndromes headache, neuropathic pain, back pain or algiomuscular pain and arthralgia were enrolled in the analysis. They were selected from the QUAST analysis sample which includes patients from 19 cooperating pain clinics. All patients had completed the German pain questionnaire prior to pain treatment and these data were compared with the last available questionnaire during the course of treatment. Outcome measures were pain intensity, psychological disability scores and patient global impression of success (PGIS). RESULTS: Analysis showed a significant improvement of all outcome measures in every MPSS stage. The greatest improvement was noted for pain intensity whereas outcome variables regarding mental health revealed the lowest improvement. Compared with patients with low pain chronification, changes in pain intensity were smaller for patients with the highest MPSS stage III but even in these patients the strength of effect was more than 0.80. About 50% of all patients showed a reduction of pain intensity of 2 or more points on an 11 point numerical rating scale and 46.6% of patients with a MPSS stage III showed this improvement. Importantly, PGIS was independent of the stage of chronification. Nearly 45% of all patients evaluated the treatment success as good or very good. CONCLUSIONS: According to the view of the patients, treatment in specialized pain centres is successful even in the highest stage of pain chronification. This notwithstanding, success of treatment must not be confounded with the efficacy of an intervention. It has to be noted that the results of the current study do not allow conclusions regarding efficacy of treatment.

[Impact of preoperative patient education on postoperative pain in consideration of the individual coping style]. / Einfluss präoperativer patienteninformationen auf postoperative schmerzen unter berücksichtigung individueller stressverarbeitung.

OBJECTIVE: the German guideline for the treatment of acute perioperative and post-traumatic pain (S3-Leitlinie zur Behandlung akuter perioperativer und posttraumatischer Schmerzen) recommends giving preoperative information about postoperative pain and how to influence it. It is expected that the effect of preoperative information is modified by psychological characteristics of the patient. One of these psychological characteristics is the individual coping style. The purpose of the study is to evaluate whether or not patients benefit from preoperative education in relation to their level of negative coping style. METHODS: the study is based on a 2×2 factorial experimental design with the experimental factor "treatment" (education vs control condition) and the factor "negative coping style" (high vs low). After informed consent 96 patients undergoing abdominal or vascular surgery were enrolled in the study. Outcomes were pain intensity, pain quality and psychic state. They were assessed by using numerical rating scales and psychometric methods of self-assessment. The data were collected preoperatively and on the first to third postoperative day. RESULTS: patients who received preoperative education experience a greater reduction in postoperative pain than patients without preoperative education do (ES=0.48). The risk for stronger pain (NRS>3) on the third postoperative day is decreased (2.1 vs 14.6%). The influence of negative coping style is altogether minimal. CONCLUSIONS: preoperative patient information has positive effects on the postoperative development of pain. Patient information is a valuable addition to the drug pain treatment. The application can be recommended regardless of the level of the patients' negative coping style.

[Characterization of chronic pain patients in German pain centers : core data from more than 10,000 patients]. / Patientenkollektiv deutscher schmerztherapeutischer Einrichtungen : Kerndaten von mehr als 10.000 Patienten.

BACKGROUND: In 1998 the board of the DGSS introduced a computerized documentation system named QUAST (quality assurance in pain therapy) building the foundation for a large, anonymous database that served as a data source for the statistical characterization of clinically relevant profiles of patients in German pain clinics. METHODS: A total of 10,054 data files collected between 1998 and 2004, including socio-demographic as well as psychometric and pain parameters were analyzed. RESULTS: The main pain diagnoses found in the database sample were back pain (37%), neuropathic pain (21.4%), soft tissue or arthralgia pain (19.5%) and headache (10.6%). The average duration of illness upon presentation at pain clinics was 7 years, nearly 20% contacted it within the first year. Of the sample, 43.8% of the patients were in the second chronicity stage and 39.0% in the third stage of the Mainz Pain Staging System (MPSS). Psychological measurements concerning despression, pain disability and quality of life indicated a great amount of psychological distress. Pronounced differences between main diagnostic groups were observed not only for psychological factors but also for direct pain parameters. CONCLUSIONS: The documented data differ from other population-based data collections. In contrast to common belief there are a considerable number of patients who find access to specialized pain therapy institutions at an early stage of their illness. The hitherto regular use of generic, syndrome-overlapping diagnosis and treatment tools should be reconsidered taking into account the differences found between the main pain diagnosis groups. Lastly, this analysis provides current data on the psychological state of chronic pain patients showing a high degree of psychological distress and underlying the need of psychotherapeutic interventions in the treatment of chronic pain patients.

[Breaking new ground in teaching medical students emergency medicine. Evaluation of a multi-centre student-guided teaching concept]. / Neue Wege in der Notfallausbildung von Medizinstudierenden. Evaluation eines multizentrischen, studentisch geleiteten Kurskonzepts.

BACKGROUND: Medical students who want to apply for preliminary medical examinations in Germany have to prove that they have attended a first-aid course. However, lay courses are often not up to the standards and needs that medical students require. As a result since 1996 members of the task group "AGEHMED", all of whom are medical students, have been teaching their peers in target groups orientated first aid and emergency techniques at medical school. The task group is (currently) active with 190 students at 6 German medical schools. All students, even those without any previous knowledge, can participate in emergency medicine education of their peers following a supervised 5-step model. OBJECTIVE: The aim of this study was to examine the results of a questionnaire that was used for evaluation of peer-guided first-aid courses at medical schools over the last 7 years and to assess its validity and reliability. MATERIALS AND METHODS: From 2000 to 2007 59 first-aid courses with 4,941 medical students were evaluated. After carrying out descriptive analyses the factorial validity and reliability (Cronbach's alpha) of the questionnaire were assessed. The inter-scale correlation of the significant factors was also analysed. RESULTS: The courses were continuously well rated. The amount of variance explained by the factors"quality of the course","learning success","comparison to other university courses","overall satisfaction" and"scheduling of the course" was 68%. The mean inter-scale correlation was r=0.23 and Cronbach's alpha was between 0.62 and 0.81. CONCLUSIONS: The peer-guided courses have been continually well received by the course participants over the last 7 years. The questionnaire shows sufficient validity and reliability. Based on these results, it can be presumed that this approach can be more widely put into practice in the education of medical students.

Patient mood and neuropsychological outcome after laparoscopic and conventional colectomy.

The study was designed to compare patients after laparoscopic and conventional colectomy with regard to early postoperative mood, cognitive function, and neurocognitive variables S100beta and neuron-specific enolase (NSE). Forty-five laparoscopic and 25 open colectomies were enrolled into the prospective study. Outcome measurements were positive and negative postoperative mood (BSKE), neuropsychological tests (Trail-Making Test; word reproduction; Stroop Test), and serum biochemical parameters (S100beta; NSE). Following laparoscopic procedure, patients described significantly better positive mood (P< .05), tended to require less time in the Trail-Making Test and Stroop Test, and had lower postoperative serum concentrations of S100beta compared to conventional colectomy patients (P< .01). The current results revealed several group differences, which, in their entirety, seem to represent a more beneficial outcome after laparoscopic colonic surgery.

[Confusion Assessment Method for the Intensive Care Unit (CAM-ICU): diagnosis of postoperative delirium in cardiac surgery]. / Confusion Assessment Method for the Intensive Care Unit (CAM-ICU): diagnostik des postoperativen delirs bei kardiochirurgischen Patienten.

OBJECTIVE: Since 2001 the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), a method for the diagnosis of delirium, has been available for the Anglo American area which can also be applied to mechanically ventilated patients. This study was conducted to answer the following questions: 1. Can a German version of the CAM-ICU be applied to patients after cardiac surgery? 2. What is the prevalence rate of postoperative delirium after cardiac surgery diagnosed by the CAM-ICU? 3. Do patients with and without the diagnosis delirium differ in the clinical variables usually associated with this disorder in cardiac surgery? METHODS: A total of 194 patients undergoing cardiac surgery served as the analysis sample (85.5% of the total group). The CAM-ICU was carried out every day for 5 days after the operation. Sociodemographic and clinical variables were collected to examine the validity of CAM-ICU. Postoperative complaints were assessed by the Anaesthesiological Questionnaire for Patients (ANP). RESULTS: Postoperatively, the CAM-ICU could be applied to almost all patients without any problems. The prevalence rate of delirium was 28.4% and 85.5% of the delirium diagnosed was a hypoactive subtype when diagnosed for the first time. Patients with delirium diagnosed by CAM-ICU were older (p<0.001), had a lower educational level (p<0.05), longer anaesthesia time and operation time (p<0.05), a longer postoperative ICU stay (p<0.001), were mechanically ventilated for a longer time postoperatively (p<0.001), more often reintubated (p<0.01) and had higher leucocytes postoperatively (p<0.10). More patients with delirium had the lowest postoperatively measured oxygen saturation below 95% (p<0.01). CONCLUSION: The CAM-ICU is an economic method for the assessment of delirium which can easily be learned. It can be applied to patients after cardiac surgery without any problems.