D. Seeger
University of Göttingen
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Schmerz | 2014
B. Arnold; T. Brinkschmidt; H.-R. Casser; A. Diezemann; I. Gralow; Dominik Irnich; U. Kaiser; B. Klasen; K. Klimczyk; J. Lutz; B. Nagel; M. Pfingsten; Rainer Sabatowski; R. Schesser; M. Schiltenwolf; D. Seeger; W. Söllner
Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management. In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.ZusammenfassungMultimodale Schmerztherapie (MMST) ist eine umfassende Behandlung komplexer Schmerzsyndrome unter Einbindung verschiedener medizinischer Disziplinen und Berufsgruppen auf der Basis eines biopsychosozialen Modells der Schmerzentwicklung. In Deutschland sind in den letzten Jahren verschiedene Einrichtungen etabliert worden, die MMST anbieten. Die MMST wurde für das tagesklinische und das stationäre Behandlungssetting in den Prozedurenkatalog medizinischer Leistungen (OPS) aufgenommen. Dabei besteht in der Versorgungspraxis oft Unklarheit, was MMST ist und welche Bestandteile ein solches Behandlungsprogramm haben soll.Aus diesem Grund hat die Ad-hoc-Kommission Multimodale Schmerztherapie der Deutschen Schmerzgesellschaft in einem mehrstufigen Konsensusprozess das vorliegende Positionspapier erarbeitet. Dabei werden die in der MMST regelhaft zur Anwendung kommenden Behandlungsmaßnahmen in den vier Kernbereichen der MMST – Medizin/Algesiologie, Psychotherapie, Physio-/Bewegungstherapie und Pflege/medizinische Assistenzberufe – dargestellt.AbstractMultimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management.In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.
Schmerz | 1996
M. Pfingsten; C. Franz; Jan Hildebrandt; Petra Saur; D. Seeger
ZusammenfassungProblem Die Relevanz psychologischer Variablen in der Behandlung chronischer Rückenschmerzpatienten konnte vielfach demonstriert werden. Dennoch ist bisher noch nicht eindeutig nachgewiesen, inwieweit subjektives Erleben der Patienten und objektiv meßbare Kriterien im Zusammenhang stehen und welche Bedeutung ihnen im Rahmen einer multimodalen Behandlung zukommt.Methode 90 vorwiegend arbeitsunfähige Patienten mit Rückenschmerzen wurden jeweils in Gruppen à 8–10 Patienten jeweils 8 Wochen lang ambulant in einem standardisierten Vorgehen verhaltensund trainingstherapeutisch behandelt. Neben Aerobic, funktionellem Kraft-training, Herz-Kreislauf-Ausdauer- und Arbeitstraining wurde über 5 Wochen täglich eine 2 stündige kognitiv-behaviorale (Gruppen-)Verhaltenstherapie durchgeführt. Die Ziele des psychotherapeutischen Vorgehens waren eine Veränderung problematischer Verhaltens-dispositionen (Inaktivität, Rückzug), maladaptiver Kognitionen (Somatisierung, Katastrophisieren, passives Krankheitsmodell), die Identifikation und der Abbau operanter (Krankheits-) Verstärkung sowie die Bearbeitung emotionaler Beeinträchtigungen (Depression). Vor und nach dem Programm sowie 6 und 12 Monate später wurden diese Patienten im Hinblick auf eine Veränderung sozialer, psychologischer, medizinischer und funktioneller Daten untersucht.ErgebnisseBis auf die Arbeitszufriedenheit und die dritte Form die Krankheitsbewältigung “kognitive Kontrolle” kam es über die Meßzeitpunkte bei allen anderen klinisch-psychologischen Variablen jeweils zu signifikanten Verbesserungen, die für die meisten Parameter im Laufe der Katamnesezeit stabil blieben. Anhand von Regressionsanalysen erfolgte eine differenzierte Beschreibung psychologischer Zusammenhänge für das Ausmaß des subjektiven Beeinträchtigungserlebens (Disability, 3 Parameter) und der 3 faktoriellen Formen der Krankheitsbewältigung des FEKB (Rumination, Informationssuche, kognitive Kontrolle). Die Operationslisierungen der ‘Disabilit’ zeigten nur geringfügige statistische Zusammenhänge zu Variablen der Schmerzbeschreibung, zu körperlichen Befunden und zu den erfaßten Formen der Krankheitsbewältigung. Dies ist ein Hinweis darauf, daß sich im “Disability-Erleben” vorrangig subjektive Patientenbewertungen widerspiegeln. Die Ergebnisse legen in der psychometrischen Diagnostik von Rückenschmerzpatienten eine konzeptuelle Trennung unterschiedlicher Merkmals-bereiche nahe, wobei das “Disability-Er. leben” eine eigenständige Komponente in der Beschreibung darstellt.SchlußfolgerungDie Analyse der Formen der Krankheitsbewältigung machte deutlich, daß es sich hier vermutlich eher um generalisierte Einstellungen zu Krankheit und Gesundheit handelt und nicht um spezifische (und damit veränderbare) Einstellungen bzw. Verhaltens-dispositionen in bezug auf Rücken-schmerzen. Nach den Ergebnissen der Untersuchung muß bezweifelt werden. ob das generelle Konzept der Krank-heitsbewältigung einen relevanten Beitrag zur Identifikation von modulierenden Faktoren bei chronischen (Rücken) Schmerzen leisten kann. Die in der vorliegenden Operationalisierung gefundenen Formen der Krankheitsbewältigung zeigten eine eher geringe Veränderung über die Zeit und zeichnete sich durch eine “Trait-Charakteristik” aus. Die Einordnung der Merkmalsbereiche “Disability” und “Krankheitsbewältigung” in das sog. “Fear-avoidance-Konzept” bringt möglicherweise weitergehendere Erkenntnisse über Chronifizierungsbe-dingungen bei Rückenschmerzen.AbstractProblemThe majority of authors agree today that psychosocial factors have more influence on a successful treatment of chronic back pain than other variables, in particular medical findings. Therefore treatments aim to integrate psychotherapeutic intervention in order to lessen emotional impairment, to change behavioral patterns (which advocate rest and the avoidance of physical activity), and to change cognitive attitudes and fears concerning exercise and work ability. Nevertheless, the interplay of cognitive measures and disability in treatment programs still remains an unclear issue.MethodsNinety disabled patients with chronic low back pain were admitted to an 8-week outpatient program of functional restoration and behavioural support. The program consisted of a pre-program (education, stretching and calisthenic exercises) and an intensive treatment period (physical exercises, back school education, cognitive behavioral group therapy, relaxation training, occupational therapy, vocational counseling), which took place for 5 weeks, 7 h a day, as an outpatient program. The targets of the psychological interventions were (a) to change maladaptive behavior (inactivity, social withdrawal) and increase the patient’s activity level at home, (b) to alter maladaptive cognitions (somatization, catastrophizing, passive expectations concerning treatment) and to improve their own positive coping skills, (c) to identify and stop operant conditioned behavior, and (d) to prevent depressive symptoms and strengthen the level of emotional control. The program’s philosophy encouraged the patients’ active efforts to improve their functional status within a therapeutic environment that reinforced positive behavior traits conductive to getting well. The main therapeutic target was to facilitate a return to work. Apart from a medical examination and a personal interview, the patients’ physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This included variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and following 6- and 12-month intervals.ResultsIn comparison with the initial values, a statistically significant improvement became evident in reducing pain, disability, depression, and psychovegetative signs (P<0.001). Nearly all results remained stable at the 6- and 12-months examinations. Apart from these results, coping measurements demonstrated little improvement in the three factorial coping dimensions. By use of regression analyses, a differentiated description of psychosocial connections became apparent in three different ways of coping (catastrophizing, searching for information, cognitive control) and parameters of disability. Disability levels corresponded poorly with pain descriptions, physical impairment and coping dimensions. This result indicates that disability should be viewed as a separate component in assessing the patients’ description of low back pain.ConclusionAn analysis of coping dimensions demonstrated that current cognitive measures might be too general to explain low back disability adequately. In addition, the results indicate that the use of the ‘catastrophizing’ factor as a separate variable is questionable, since it may simply be a symptom of depression. The relevance of coping as a sensitive parameter for change is also addressed. It is suggested that an alteration in coping strategies may be an important treatment effect, but is subject to individual prerequisites to maximize treatment response. Thus, future research must focus on the complex interactions between personality variables, environmental factors, and the coping demands posed by the specific nature of pain problems. A more lengthy evaluation of socalled ‘fear-avoidance beliefs’ in combination with ‘disability’ and coping dimensions could possibly lead to further treatment on the development of chronicity in chronic low back pain patients.
Schmerz | 2009
P. Schöps; D. Seeger
For almost all pain syndromes, whether caused by tumours or not, physicomedical therapies are used as primary or accompanying measures to treat chronic and acute pain. The selection of suitable treatments is, however, often challenging, as there are clear discrepancies between the results of controlled studies on the one hand and the positive results based on individual observations on the other. This article presents an overview of those methods, therapeutic agents, and techniques within the broad range of physicomedical treatments that show a pain-modulating effect and have proven their efficiency for treating acute and chronic pain.
Schmerz | 2014
B. Arnold; T. Brinkschmidt; H.-R. Casser; A. Diezemann; I. Gralow; Dominik Irnich; U. Kaiser; B. Klasen; K. Klimczyk; J. Lutz; B. Nagel; M. Pfingsten; Rainer Sabatowski; R. Schesser; Marcus Schiltenwolf; D. Seeger; W. Söllner
Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management. In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.ZusammenfassungMultimodale Schmerztherapie (MMST) ist eine umfassende Behandlung komplexer Schmerzsyndrome unter Einbindung verschiedener medizinischer Disziplinen und Berufsgruppen auf der Basis eines biopsychosozialen Modells der Schmerzentwicklung. In Deutschland sind in den letzten Jahren verschiedene Einrichtungen etabliert worden, die MMST anbieten. Die MMST wurde für das tagesklinische und das stationäre Behandlungssetting in den Prozedurenkatalog medizinischer Leistungen (OPS) aufgenommen. Dabei besteht in der Versorgungspraxis oft Unklarheit, was MMST ist und welche Bestandteile ein solches Behandlungsprogramm haben soll.Aus diesem Grund hat die Ad-hoc-Kommission Multimodale Schmerztherapie der Deutschen Schmerzgesellschaft in einem mehrstufigen Konsensusprozess das vorliegende Positionspapier erarbeitet. Dabei werden die in der MMST regelhaft zur Anwendung kommenden Behandlungsmaßnahmen in den vier Kernbereichen der MMST – Medizin/Algesiologie, Psychotherapie, Physio-/Bewegungstherapie und Pflege/medizinische Assistenzberufe – dargestellt.AbstractMultimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management.In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.
Schmerz | 2001
D. Seeger
Zusammenfassung. Aufgrund nicht zufriedenstellender Erfolge in der Behandlung von Patienten mit chronischen Rückenschmerzen mit den eher passiven Maßnahmen der physikalischen Therapie entwickelte sich in den 80er Jahren in den USA eine multimodale Konzeption (Functional restoration/PRIDE), wobei Aktivität und Training den Grundlagen der Sportmedizin entsprechend in den Vordergrund gestellt wurden. Neuere Erkenntnisse der letzten Jahre weisen im Gegensatz zu der Auffassung, dass strukturelle Veränderungen vorrangig einen Anteil am Schmerzgeschehen haben, auf die größere Bedeutung von funktionellen Störungen hin, die unter Berücksichtigung des psychosozialen Umfeldes einer Person, besonders bei chronischen Beschwerden, einen neuen, umfangreicheren Behandlungsansatz im Sinne einer multimodalen Konzeption benötigen. Dieser Beitrag berücksichtigt zum einen die Leitlinie für die Therapie von “Kreuzschmerzen” der Deutschen Arzneimittelkommission [2] und setzt sie in Beziehung zu der Internationalen Klassifikation der Weltgesundheitsorganisation (International Classification of Functioning and Disability, 2nd version, ICIDH-2 [21]) und den neuen Heilmittelrichtlinien. Zum anderen wird unter Berücksichtigung der Ergebnisse wissenschaftlicher Untersuchungen sowie eigener Erfahrungen in der Umsetzung multimodaler Programme eine Zuordnung zu physiotherapeutischen Maßnahmen zu ICIDH-2-Indikationen vorgeschlagen. Ziel dieser Maßnahmen ist eine Verringerung der Chronifizierung. Dies setzt eine frühzeitige Orientierung der Therapieziele an realistischen Alltagsbelastungen schon in der subakuten Phase und zu Beginn einer Therapie bei chronischen Beschwerden voraus. Eine praktische Umsetzung wird möglich, wenn klare diagnostische Wege empfohlen werden können und sowohl Kooperation als auch Kommunikation zwischen Ärzten und Therapeuten weiter verbessert werden. Ein erster Schritt ist mit der Umsetzung der neuen Heilmittelrichtlinien getan.Abstract. These times of changing paradigms raise the question of the indications for and limits of physical therapy in back pain management. At present, several national and international guidelines for the care of chronic back pain are available. Unfortunately, the guidelines are often inconsistent concerning physiotherapy. An encompassing framework for an effective, efficient, and appropriate physiotherapy treatment needs to be developed. Within the German national health system, the “Arzneimittelkommission” [2] issued guidelines for low back pain. These guidelines endeavour to distinguish between disease related specific back pain and non specific back pain of a more functional or mechanical origin. Furthermore, the “Bundesausschuß der Ärzte und Krankenkassen” in Germany dispatched guidelines (Heilmittelrichtlinien) for the prescription of “Heilmittel” (remedies other than drugs) on October 16th, 2000. These guidelines seek to appropriately refer, assign and limit the physiotherapy treatment of back pain according to a set indications catalogue. On an international basis, the World Health Organisation (WHO) [21] offers well established guidelines for the “International Classification of Functioning and Disability”, 2nd version (ICIDH-2). These guidelines describe the progressive health dysfunction over three major levels: 1) body functions and structures, 2) activities of an individual, and 3) participation of an individual in social and other essential aspects of life. National and international scientific studies support the use of ICIDH-2-categories and suggest that different back pain management is required at different levels of dysfunction. For example, there is a trend to prescribe increasingly active types of treatment instead of passive ones for increasing levels of dysfunction [54]. Multimodal treatment programs [17, 29], which include physical activity, training and psychological programs as well as training of activities of daily living (ADL) (“workhardening program”) demonstrate particular benefit in the treatment of chronic low back pain at the disability and handicap level. Current physical therapy on back pain management operates at all three categories of ICIDH-2. Therapists aim to treat local spinal symptoms and their secondary functional changes, reorganise altered physiological patterns and improve the psycho-social state of the patient. This level overlaps with the fields of occupational therapy (training of work related tasks), psychosocial therapy (training of social competence etc.) and physical training (improvement of physical performance). Physical training as a means of physical therapy, combined with certain aspects of occupational therapy, offers an important possibility of transfer into workday life. Borders between neighbouring fields are not sharp. Physical therapy is contraindicated only in rare cases (e.g. clear indications for surgery; predominant psychological disorder). Unfortunately, the national German guidelines for physical therapy (Heilmittelrichtlinien) which have been put in effect by July 1st, 2001 appear to direct the prescription of physical therapy primarily to treating structural and functional dysfunction. At an activity level, occupational therapy is recommended only for the treatment of specific diseases. Moreover, recommendations for physical therapy for patients with an acute impairment and those with a chronic handicap are almost identical. This is not in accordance with the scientific evidence for effective treatment. So far there are no studies investigating the various implications of ICIDH-2-guidelines for physical therapy management of back pain. Considering the ICIDH-2 directives it is not helpful to judge efficacy solely by somatic parameters such as mobility and muscle force. A patient without good mobility could still return to work. A subjective feeling of well being or low disability on the side of the patient is an equally important parameter of successful treatment as the good physical capacity for daily life.
Schmerz | 2015
M. Egan; D. Seeger; P. Schöps
ZusammenfassungPatienten, die sich zur Physiotherapie oder physikalischen Medizin anmelden, kommen in der Regel mit Schmerzproblemen und/oder Funktionseinschränkungen. Obwohl das Hauptaugenmerk der Therapeuten in der Untersuchung auf spezifische Körperstrukturen und biomechanische Zusammenhänge gerichtet ist, wird in den letzten Jahrzehnten parallel dazu das Verständnis zentralnervöser Prozesse und psychosozialer Einflussfaktoren mit einbezogen. Ziel ist es dabei, eine verbesserte Funktionalität und Partizipation des Patienten durch möglichst schmerzarme und belastbare Bewegung zu erreichen. Physiotherapie im Rahmen der Schmerzbehandlung ist im Wandel, zum einen durch die zunehmende Akademisierung, zum anderen durch verstärktes interdisziplinäres Arbeiten. Jedoch bestehen in der Herangehensweise an chronische Schmerzpatienten noch große Unterschiede zwischen Therapeuten, die Patienten im Rahmen von multimodalen Konzepten in Schmerzkliniken behandeln, und solchen, die in niedergelassenen Praxen dem Heilmittelkatalog nach ärztlicher Verordnung folgen müssen. Der vorliegende Beitrag informiert darüber, inwieweit nationale und internationale Impulse zur Entwicklung unterschiedlicher Konzepte für passive Therapiemaßnahmen und aktive/funktionelle Bewegungstrainings am Standort Deutschland beigetragen haben. Ein Anspruch an die Physiotherapie wäre es, zukünftig mehr Evidenz zu Behandlungserfolgen und Wirkmechanismen einzelner Maßnahmen und Behandlungskonzepte zu belegen, um diese differenzierter bei Patienten mit akuten, subakuten und chronischen Beschwerden einsetzen zu können.AbstractPatients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.
Schmerz | 2015
M. Egan; D. Seeger; P. Schöps
ZusammenfassungPatienten, die sich zur Physiotherapie oder physikalischen Medizin anmelden, kommen in der Regel mit Schmerzproblemen und/oder Funktionseinschränkungen. Obwohl das Hauptaugenmerk der Therapeuten in der Untersuchung auf spezifische Körperstrukturen und biomechanische Zusammenhänge gerichtet ist, wird in den letzten Jahrzehnten parallel dazu das Verständnis zentralnervöser Prozesse und psychosozialer Einflussfaktoren mit einbezogen. Ziel ist es dabei, eine verbesserte Funktionalität und Partizipation des Patienten durch möglichst schmerzarme und belastbare Bewegung zu erreichen. Physiotherapie im Rahmen der Schmerzbehandlung ist im Wandel, zum einen durch die zunehmende Akademisierung, zum anderen durch verstärktes interdisziplinäres Arbeiten. Jedoch bestehen in der Herangehensweise an chronische Schmerzpatienten noch große Unterschiede zwischen Therapeuten, die Patienten im Rahmen von multimodalen Konzepten in Schmerzkliniken behandeln, und solchen, die in niedergelassenen Praxen dem Heilmittelkatalog nach ärztlicher Verordnung folgen müssen. Der vorliegende Beitrag informiert darüber, inwieweit nationale und internationale Impulse zur Entwicklung unterschiedlicher Konzepte für passive Therapiemaßnahmen und aktive/funktionelle Bewegungstrainings am Standort Deutschland beigetragen haben. Ein Anspruch an die Physiotherapie wäre es, zukünftig mehr Evidenz zu Behandlungserfolgen und Wirkmechanismen einzelner Maßnahmen und Behandlungskonzepte zu belegen, um diese differenzierter bei Patienten mit akuten, subakuten und chronischen Beschwerden einsetzen zu können.AbstractPatients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.
Schmerz | 2015
M. Egan; D. Seeger; P. Schöps
ZusammenfassungPatienten, die sich zur Physiotherapie oder physikalischen Medizin anmelden, kommen in der Regel mit Schmerzproblemen und/oder Funktionseinschränkungen. Obwohl das Hauptaugenmerk der Therapeuten in der Untersuchung auf spezifische Körperstrukturen und biomechanische Zusammenhänge gerichtet ist, wird in den letzten Jahrzehnten parallel dazu das Verständnis zentralnervöser Prozesse und psychosozialer Einflussfaktoren mit einbezogen. Ziel ist es dabei, eine verbesserte Funktionalität und Partizipation des Patienten durch möglichst schmerzarme und belastbare Bewegung zu erreichen. Physiotherapie im Rahmen der Schmerzbehandlung ist im Wandel, zum einen durch die zunehmende Akademisierung, zum anderen durch verstärktes interdisziplinäres Arbeiten. Jedoch bestehen in der Herangehensweise an chronische Schmerzpatienten noch große Unterschiede zwischen Therapeuten, die Patienten im Rahmen von multimodalen Konzepten in Schmerzkliniken behandeln, und solchen, die in niedergelassenen Praxen dem Heilmittelkatalog nach ärztlicher Verordnung folgen müssen. Der vorliegende Beitrag informiert darüber, inwieweit nationale und internationale Impulse zur Entwicklung unterschiedlicher Konzepte für passive Therapiemaßnahmen und aktive/funktionelle Bewegungstrainings am Standort Deutschland beigetragen haben. Ein Anspruch an die Physiotherapie wäre es, zukünftig mehr Evidenz zu Behandlungserfolgen und Wirkmechanismen einzelner Maßnahmen und Behandlungskonzepte zu belegen, um diese differenzierter bei Patienten mit akuten, subakuten und chronischen Beschwerden einsetzen zu können.AbstractPatients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.
Schmerz | 2014
B. Arnold; T. Brinkschmidt; H.-R. Casser; A. Diezemann; I. Gralow; Dominik Irnich; U. Kaiser; B. Klasen; K. Klimczyk; J. Lutz; B. Nagel; M. Pfingsten; Rainer Sabatowski; R. Schesser; Marcus Schiltenwolf; D. Seeger; W. Söllner
Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management. In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.ZusammenfassungMultimodale Schmerztherapie (MMST) ist eine umfassende Behandlung komplexer Schmerzsyndrome unter Einbindung verschiedener medizinischer Disziplinen und Berufsgruppen auf der Basis eines biopsychosozialen Modells der Schmerzentwicklung. In Deutschland sind in den letzten Jahren verschiedene Einrichtungen etabliert worden, die MMST anbieten. Die MMST wurde für das tagesklinische und das stationäre Behandlungssetting in den Prozedurenkatalog medizinischer Leistungen (OPS) aufgenommen. Dabei besteht in der Versorgungspraxis oft Unklarheit, was MMST ist und welche Bestandteile ein solches Behandlungsprogramm haben soll.Aus diesem Grund hat die Ad-hoc-Kommission Multimodale Schmerztherapie der Deutschen Schmerzgesellschaft in einem mehrstufigen Konsensusprozess das vorliegende Positionspapier erarbeitet. Dabei werden die in der MMST regelhaft zur Anwendung kommenden Behandlungsmaßnahmen in den vier Kernbereichen der MMST – Medizin/Algesiologie, Psychotherapie, Physio-/Bewegungstherapie und Pflege/medizinische Assistenzberufe – dargestellt.AbstractMultimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management.In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.
Schmerz | 2014
B. Arnold; T. Brinkschmidt; H.-R. Casser; A. Diezemann; I. Gralow; Dominik Irnich; U. Kaiser; B. Klasen; K. Klimczyk; J. Lutz; B. Nagel; M. Pfingsten; Rainer Sabatowski; R. Schesser; Marcus Schiltenwolf; D. Seeger; W. Söllner
Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management. In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.ZusammenfassungMultimodale Schmerztherapie (MMST) ist eine umfassende Behandlung komplexer Schmerzsyndrome unter Einbindung verschiedener medizinischer Disziplinen und Berufsgruppen auf der Basis eines biopsychosozialen Modells der Schmerzentwicklung. In Deutschland sind in den letzten Jahren verschiedene Einrichtungen etabliert worden, die MMST anbieten. Die MMST wurde für das tagesklinische und das stationäre Behandlungssetting in den Prozedurenkatalog medizinischer Leistungen (OPS) aufgenommen. Dabei besteht in der Versorgungspraxis oft Unklarheit, was MMST ist und welche Bestandteile ein solches Behandlungsprogramm haben soll.Aus diesem Grund hat die Ad-hoc-Kommission Multimodale Schmerztherapie der Deutschen Schmerzgesellschaft in einem mehrstufigen Konsensusprozess das vorliegende Positionspapier erarbeitet. Dabei werden die in der MMST regelhaft zur Anwendung kommenden Behandlungsmaßnahmen in den vier Kernbereichen der MMST – Medizin/Algesiologie, Psychotherapie, Physio-/Bewegungstherapie und Pflege/medizinische Assistenzberufe – dargestellt.AbstractMultimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management.In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.