[What does pain intensity mean from the patient perspective? : A qualitative study on the patient perspective of pain intensity as an outcome parameter in treatment evaluation and on the interpretability of pain intensity measurements]. / Was bedeutet Schmerzintensität aus Sicht der Patienten? : Eine qualitative Studie zur Patientenperspektive auf Schmerzstärke als Konstrukt in der Therapieevaluation und die Interpretierbarkeit der Schmerzstärkemessung.

BACKGROUND: Pain intensity (PI) is a common outcome parameter in effectiveness studies on interdisciplinary multimodal pain therapy (IMPT), despite the fact that IMPT highlights dealing with rather than reducing chronic pain. Moreover, the measurement of pain intensity as a highly subjective experience is problematic. Patient participation is absolutely essential to examine the relevance of PI as a criterion of treatment success as well as to select/develop suitable measurement methods. METHOD: A qualitative multicenter study was conducted using focus groups with 69 patients (18-77 years; 80% female) at four different IMPT centers in Germany to discuss pain intensity as a therapy outcome parameter in IMPT, as well as the interpretability and feasibility of common measurement methods. RESULTS: The discussions emphasized that PI is a relevant, but not the primary, outcome in IMPT for patients. Patients' statements also demonstrate that there are some problems in measuring PI, for instance with regard to pain attacks. CONCLUSIONS: The focus group discussions suggested that, due to the highly subjective nature of PI, as well as (verbal) inaccuracies and a lack of standardization in common instruments, the measurement of pain intensity is a challenging task. These limitations should be taken into account in future studies.

[Treatment of elderly with chronic pain in geriatric care and pain therapy facilities in Germany. Survey results]. / Therapie chronischer Schmerzen bei Älteren in schmerztherapeutischen und geriatrischen Einrichtungen in Deutschland. Ergebnisse einer Befragung.

BACKGROUND: Even though there are no satisfactory data available on the prevalence of chronic pain in the elderly, it is certainly a common problem in Germany. The goal of this study is to provide information on the treatment of elderly patients with chronic pain in geriatric care and pain therapy facilities in Germany. METHOD: Throughout Germany geriatric and pain clinics were asked by email about their treatment practice of patients with chronic pain. The questions related to four types of patients sharing the same chronic pain characteristics and comorbidities but differing with respect to cognitive and physical impairment. The questions were divided into the following areas: equipment, staff, patient care, documentation, and cooperation. RESULTS: Replies from a total of 85 institutions were evaluated. The response rates were approximately 5 % for geriatric units and 10 % for pain units. More patients with chronic pain are treated in geriatrics units than in pain therapy facilities due to larger capacities. Although all four types of patients are treated in both types of facilities, the functionally more competent patients are more common in pain therapy facilities. In geriatrics, the inverse relationship was found. Differences exist in the staff structure and qualification, frequency and refinement of individual and group therapies, assessments used, teamwork, documentation, and cooperation with outpatient care. CONCLUSION: Due to the differences between geriatric and pain management departments shown in all investigated areas, an exchange between these two cross-sectional subjects could help to improve inpatient, outpatient and intersectoral treatment of elderly patients with chronic pain.

[Psychological assessment and psychotherapy for chronic pain in the elderly]. / Psychologische Diagnostik und Psychotherapie bei chronischen Schmerzen im Alter.

Systematic reviews of psychosocial assessment and effectiveness of psychotherapy for chronic pain syndromes in older patients are rare. However, it is of particular importance to consider the psychosocial aspects of elderly people with chronic pain. This narrative review describes recommended German-language assessments of the psychosocial dimensions of pain and summarizes existing studies of psychological therapy approaches for chronic pain in old age. Effective psychometric instruments are available for the assessment of cognitive function, pain-specific attitudes, depression, fear of falling, interpersonal processes and social activities, pain management, pain acceptance, disability, psychological well-being, and quality of life. Further experience with the use of these instruments with cognitively impaired or geriatric patients is required. The efficacy of age-adapted cognitive behavioral therapy and multimodal therapy for older patients has been documented. However, there is often a lack of supporting documentation about important result parameters (e.g., quality of life, functioning in everyday life, or pain acceptance). Overall, chronic pain in elderly people requires a biopsychosocial-spiritual model of pain. More attention should be given in research and daily practice to religiosity/spirituality as a possible means of coping, while mindfulness- and acceptance-based therapies should be further explored.

[Multimodal group therapy for the elderly with chronic pain: concept and results in a before and after comparison]. / Multimodale Gruppentherapie bei Senioren mit chronischen Schmerzen : Konzept und Ergebnisse im Prä-post-Vergleich.

BACKGROUND: Multimodal pain therapy programs are increasingly being recommended as an effective treatment option also for elderly patients with chronic pain. However, data from Germany are limited. PATIENTS AND METHODS: A multimodal group program adapted to the specific needs of elderly pain patients over 70 years old (20 treatment days, over 10 weeks) was started in our pain clinic in June 2005. We evaluated clinical, psychometric and physical data at the beginning and at the end of the treatment program, and compared outcome results with a waiting list control group. RESULTS: A total of 24 patients (mean age 76.2+/-4.79 years) could be evaluated of which 21 patients suffered from musculoskeletal pain, 2 from neuropathic pain syndromes and 1 from headache. In the waiting-list control group 13 patients were included. There were no significant between-group differences regarding age, stages of chronification, pain intensity, duration of pain and pain diagnosis. CONCLUSIONS: A multimodal pain therapy program for elderly patients (over 70 years old) is an effective treatment option to reduce pain intensity and pain disability. Furthermore, life quality and physical performance improved. Long-term effects still have to be evaluated.