[Anonymize or personalize? : Does social desirability influence the response behavior of chronic pain patients?] / Anonymisieren oder personalisieren? : Beeinflusst die soziale Erwünschtheit das Antwortverhalten von chronischen Schmerzpatienten?

BACKGROUND: The subjective state of health with respect to pain and psyche was surveyed utilizing validated pain questionnaires in patients undergoing special pain therapy and represents the basis for targeted treatment measures. OBJECTIVE: The purpose of this study was to investigate the possible distortion of answers due to social desirability of responses in chronic pain patients. MATERIAL AND METHODS: During two survey periods assessing patient satisfaction using both anonymized and personalized questionnaires, the effects arising from socially desirable response patterns were analyzed. The sample consisted of chronic pain patients being treated in an inpatient therapy setting. RESULTS: In both periods of observation no significant impact on the response behavior of chronic pain patients was found in personalized or anonymized questionnaires. CONCLUSION: The results of the study suggest that the responses of chronic pain patients with respect to their subjective state of health are not influenced by social desirability. Thus, scoring systems such as the German pain questionnaire will not be influenced by social desirability in chronic pain patients and can therefore be used as a part of diagnostics and therapy planning.

[Multimodal pain therapy for treatment of chronic pain syndrome. Consensus paper of the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society on treatment contents]. / Multimodale Schmerztherapie für die Behandlung chronischer Schmerzsyndrome. Ein Konsensuspapier der Ad-hoc-Kommission Multimodale interdisziplinäre Schmerztherapie der Deutschen Schmerzgesellschaft zu den Behandlungsinhalten.

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.

[Intersectoral pain treatment. The Algesiologikum group]. / Sektorübergreifende schmerzmedizinische Versorgung. Der Algesiologikum-Verbund.

Cross-sectoral clinical pathways for chronic pain patients in standard and routine care are a major challenge for the German healthcare system. The Algesiologikum group has developed such clinical pathways including an essential infrastructure. Cooperation partners of the Algesiologikum group are two outpatient medical care units, one neurosurgery practice and four hospitals. In the outpatient sector as well as in the inpatient sector the Algesiologikum group provides a multidisciplinary team caring for chronic pain patients. The range of treatment in the hospitals includes multimodal, invasive and surgical pain therapy. The present report illustrates possibilities and frontiers of the Algesiologikum concept based on all patients treated since 2009.

[Role of cognitive pain coping strategies for depression in chronic back pain. Path analysis of patients in primary care]. / Der Beitrag kognitiver Schmerzverarbeitung zur Depressivität bei Rückenschmerzpatienten. Eine pfadanalytische Untersuchung an Patienten aus der primärärztlichen Versorgung.

BACKGROUND: The concurrent occurrence of chronic pain syndromes and depressive symptoms is a commonly observed phenomenon.The aim of the present study was to illuminate the mediating role of specific cognitive pain coping strategies as a connective link between pain and depression. METHODS: A total of 122 chronic and chronic recurrent simple back pain patients were examined in view of the connection between pain, cognitive pain coping strategies, and depression. RESULTS: The results of the path analysis support the assumption of a mediating effect of cognitive coping strategies between pain and depression (GFI = 0.99; AGFI = 0.96). It could be shown, that cognitive coping mediates the link between pain and depression in back pain patients. CONCLUSION: The results give further support for the cognitive mediation hypothesis and enhance it by pointing out the role of specific pain-related cognitive appraisals.

[Psychological mechanisms in the transition from acute to chronic pain: over- or underrated?]. / Psychologische Mechanismen in Prozess der Schmerzchronifizierung - Unter- oder überbewertet?

INTRODUCTION: During the last 20 years a great number of studies have emphasized the potential role of psychological factors as relevant predictors for the first onset of back pain as well as for the development of chronic pain. The formulation of a biopsychosocial perspective of the etiology and chronicity of back pain was a natural consequence. Actual questions concern the relative impact of psychological risk factors in the process of chronicity of back pain compared to biomedical, social and occupational factors. METHODS: Whereas several review articles regarding the role of psychological risk factors are available up to now, a recently published review conducted by Steven Linton was the first systematic analysis of well controlled prospective studies published since 1967. Using a grading system similar to that recommended for guidelines the author defined a level A evidence when at least two good-quality prospective studies supported the prospective power of a variable. Level B evidence had support from one prospective study. Level C represented inconclusive data and level D indicated that no studies met the criteria. Based on a literature search of more than 900 studies, 37 good-quality prospective studies were analysed in detail. RESULTS: The results indicated level A evidence for the following interrelations: (1) Psychosocial variables, especially chronic distress in daily life, depression and work dissatisfaction were clearly associated with the onset of back and neck pain (2). Psychological variables, especially chronic stress in daily life, work dissatisfaction, depression and pain-related cognitions and coping behaviour were clearly linked to the transition from acute to chronic pain and disability (3). Psychological variables generally had more prospective power than biomedical, social or objective occupational variables. Among the pain-related cognitions, catastrophizing and fear-avoidance-beliefs yielded the most empirical support. Among coping behaviour passive coping stretegies such as avoiding behaviour was most important. At least level B evidence has been shown for the counterpart of an extreme suppressive coping behaviour. Patients who tended to suppress or ignore pain in order to finish all activities they started, who were unable to integrate phases of passive relaxation into the daily routine displayed a high risk of chronicity of pain 6 months after an acute phase of pain. One international and two German good-quality prospective studies have shown the predictive power of a maladaptive suppressive behaviour pattern. Based on the avoidance-endurance-model of pain chronification, both extreme and one-sided passive pain coping as well as one-sided suppressive coping modes were conceptualized as maladaptive due to the process of chronicity. We assume that extreme passive behaviour will lead to immobility and muscular atrophy. Neurophysiological processes of sensitization will further lead to the development of chronic pain. On the other hand, extreme suppressive behaviour will lead to an overuse of muscles and joints with a repetitive combination of muscular hyperactivity and pain. These repetitive pain experiences will also elicit neurophysiological processes of sensitization. (4) Psychosocial variables displayed more predictive power than biomedical or biomechanical factors. (5) Psychosocial factors may be used as predictors of the risk for developing long-term pain and disability. Mixed empirical evidence has been shown for the role of personality factors (level C evidence) and no support has been found for the idea of a "pain prone" personality disorder or for the role of sexual and physical abuse. DISCUSSION: 20 years of research, several qualitative reviews and a recently published systematic review of 37 good-quality prospective studies regarding the role of psychological, biomedical, social and objective occupational factors in the process of chronicity of back pain revealed that psychological factors are significantly related to the onset of back pain as well as to the development of chronic pain. Furthermore, the psychological factors displayed more predictive power than biomedical or biomechanical variables. As a consequence for clinical practice, these psychological risk factors have to be considered as "yellow flags" if a back pain problem won't respond to medical treatment for more than four weeks. As a further consequence, special risk factor - based psychosocial interventions should be offered in addition to the medical treatment to patients with high psychological risk factors for the development of chronic pain. The efficacy of such an interdisciplinary care in the very early phases of back pain in order to prevent chronicity of pain and disability has been published recently by our group.