Multimodal pain therapy

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The approach of the multimodal pain goes from a combined pain treatment, which at least seven days interdisciplinary treatment of patients with chronic pain states (z. B. spinal disorders, including cancer pain ), including at least two disciplines , including a psychiatric , psychosomatic or psychological discipline , according to a medical treatment plan with treatment management. There are various standardized procedures with a duration of up to five weeks under this name. Some programs also start a new, short treatment after a longer break to refresh the treatment content.

Multimodal pain therapy provides the components of medical treatment, intensive information and training on the basis of a biopsychosocial pain model, physical activation (if possible based on behavioral principles), psychotherapeutic treatment measures (individual / group therapy, stress management , functional analysis) and occupational therapy treatment components almost equally alongside one another

indication

For patients with low back pain , if the pain persists for 6 weeks and if there are restrictions in everyday life, the presence of risk factors for chronification should be checked. If these are available, multimodal pain therapy may be indicated ( indicated ).

If the pain persists for more than 12 weeks, the indication for multimodal pain therapy should definitely be checked.

Multimodal pain therapy is indicated if the following requirements are met:

  • previous, less intensive therapy was unsuccessful
  • there is a change in the pain symptoms (more frequent or more intense pain, pain in new parts of the body)
  • there is an increase in drug consumption
  • there are psychosocial risk factors
  • the patient makes frequent use of the medical care system
  • There are comorbidities that affect the pain or make therapy more difficult

For patients with chronic headaches, there is also evidence of the better effectiveness of multimodal pain therapy compared to purely pharmacological or purely psychotherapeutic treatment, but no precise indication criteria exist to date.

To ensure the course of treatment, the result is generally checked by means of a standardized therapeutic assessment (e.g. on pain intensity, depression, functional capacity and quality of life) with the following interdisciplinary team meeting.

treatment

  • In the treatment of chronic back pain: significant
  • With the multimodal pain therapy Dachau (independent of diagnosis): 63% were able to return to work

Conventional, purely somatically oriented treatment of chronic pain does not show a satisfactory quality of results for those affected. Only around 10% of conventionally treated back pain patients benefit from a corresponding therapy. After an extensive analysis of accounting data from 2006 to 2010, the Barmer GEK came to the conclusion that multimodal pain therapy for back pain is the most effective from both a medical and an economic point of view compared to operations or injection therapy. Since 2012, the employers' liability insurance association has also been increasingly introducing multimodal pain therapy centers in their accident clinics - such as in Frankfurt , Duisburg, Ludwigshafen or Murnau - but these treatments are usually only offered to patients insured by the employers liability insurance association .

Against this background, national and international specialist societies call for the inclusion of multimodal therapy offers, in particular psychotherapeutic interventions. Unfortunately, the current treatment situation in Germany does not reflect the scientific findings that have led to this requirement. Rather, multimodal pain therapy is still the exception in Germany.

Predictors of Treatment Success

According to a recent study by Donath et al. (2015), patients in particular benefit from multimodal pain therapy who are severely affected by their everyday pain at the start of treatment, who report high pain intensity at the start of treatment and those who report less pain in the 6 months before the start of treatment Had visits to the doctor for pain.

evidence

According to a recent review, the measurement of success in multimodal pain therapy (MMST) has so far been very inconsistent. Out of 70 studies, not one study used exactly the same operationalization as another study. In the course of developing patient-assessed quality criteria (“patient reported outcomes”), Donath et al. (2015) propose a combined success criterion for measuring the success of treatment in multimodal pain therapy. Patients have to improve in the areas of pain intensity, impairment caused by pain, depression and quality of life.

A Cochrane review concluded that there was no difference to other active treatments in terms of effect on pain, subjective disability and length of incapacity for work. An umbrella review (overview article based on meta-analyzes ) also indicated that there was a lack of reliable evidence for the effectiveness of MMSD.

See also

literature

  • Bernhard Arnold: Multimodal pain therapy in Bavaria. In: Bayerisches Ärzteblatt . 3/2005, p. 216ff. (online) (About the implementation phase)
  • Thomas Flöter, Manfred Zimmermann (Ed.): The multimorbid pain patient. Thieme, Stuttgart 2003, ISBN 3-13-133071-6 .
  • Uwe Junker, Thomas Nolte (Hrsg.): Basics of special pain therapy. Curriculum Special Pain Therapy of the German Society for Pain Therapy e. V. according to the course book of the German Medical Association . Urban & Vogel, Munich 2005, ISBN 3-89935-218-1 .
  • Jan Hildebrandt (Ed.): Göttingen Back Intensive Program (GRIP). The manual. Congress-Compact-Verlag, Berlin 2003, ISBN 3-9808025-8-2 .
  • Carolin Donath, colleague: Measuring success in pain therapy. In: BMC Health Services Research.

Individual evidence

  1. ↑ J. Hildebrandt, M. Pfingsten: From GRIP to multimodal pain therapy. In: The orthopedist. 10, 2009, pp. 885-895. doi: 10.1007 / s00132-009-1479-6
  2. ↑ a b c Available under National Care Guideline for Kreuzschmerz Bundesärztekammer (BÄK), National Association of Statutory Health Insurance Physicians (KBV), Association of Scientific Medical Societies (AWMF).
  3. ↑ Hans-Christoph Diener (Ed.): Guidelines for Diagnostics and Therapy in Neurology. 4th, revised edition. Thieme, Stuttgart 2008, ISBN 978-3-13-132414-6 , p. 654 ff.
  4. ↑ S. Meier, E. Neubauer, M. Schiltenwolf: Measurement of treatment success for chronic back pain. In: The pain. 23: 1/2009, pp. 54-58. doi: 10.1007 / s00482-008-0731-z
  5. ↑ K. Pöhlmann, T. Tonhauser, P. Joraschky , B. Arnold: Die Multimodale Schmerztherapie Dachau (MSD). Data on the effectiveness of a diagnosis-independent multimodal therapy program for back pain and other pain. In: The pain. 23: 1/2009, pp. 40-46. doi: 10.1007 / s00482-008-0727-8
  6. ^ E. Lang, R. Eisele, H. Jankowsky et al.: Quality of results in outpatient care for patients with chronic back pain. In: The pain. 3 (2000), pp. 146-160.
  7. ↑ hil / aerzteblatt.de: Health insurance company recommends multimodal pain therapy for back pain. In: aerzteblatt.de . August 29, 2012, accessed November 18, 2015 .
  8. ↑ Inpatient multimodal pain therapy ( memento of the original from November 19, 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. Professional Association Accident Clinic Frankfurt @1@ 2Template: Webachiv / IABot / www.bgu-frankfurt.de
  9. ↑ Desirable Characteristics for Pain Treatment Facilities. ( Memento from August 24, 2012 in the web archive archive.today ) International Association for the Study of Pain (IASP)
  10. ^ Improve care, German pain society eV
  11. ↑ H. Kayser, R. Thoma et al: [Structure of outpatient pain therapy in Germany. Results of a survey]. In: pain. Volume 22, Number 4, August 2008, pp. 424-432. doi: 10.1007 / s00482-008-0650-z . PMID 18437429 .
  12. ^ A b C. Donath, L. Dorscht, E. Gräßel, R. Sittl & C. Schön: Searching for success: Development of a combined patient-reported-outcome ("PRO") criterion operationalizing success in multi-modal pain therapy . In: BMC Health Services Research. 15, 2015, p. 272. doi: 10.1186 / s12913-015-0939-4
  13. ^ S. Deckert, U. Kaiser, C. Kopkow, F. Trautmann, Rainer Sabatowski, J. Schmitt: A systematic review of the outcomes reported in multimodal pain therapy for chronic pain. In: European Journal of Pain. 2015. doi: 10.1002 / ejp.721
  14. ↑ Marin TJ, van Eerd D, Irvin E, Couban R, Koes BW, Malmivaara A, van Tulder MW, Kamper SJ (2017): Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database of Systematic Reviews, Issue 6
  15. ↑ Dragioti E, Evangelou E, Larsson B, Gerdle B: Effectiveness of Multidisciplinary Programs for Clinical Pain Conditions: An Umbrella Review. J Rehabil Med; 2018; 50: Epub ahead of print.