Over-, under- and misuse of pain treatment in Germany
Copyright policy )Over-, under- and misuse of pain treatment in Germany
Background The HTA-report (Health Technology Assessment) deals with over- and undertreatment of pain therapy. Especially in Germany chronic pain is a common reason for the loss of working hours and early retirement. In addition to a reduction in quality of life for the affected persons, chronic pain is therefore also an enormous economic burden for society. Objectives Which diseases are in particular relevant regarding pain therapy? What is the social-medical care situation regarding pain facilities in Germany? What is the social-medical care situation in pain therapy when comparing on international level? Which effects, costs or cost-effects can be seen on the micro-, meso- and macro level with regard to pain therapy? Among which social-medical services in pain therapy is there is an over- or undertreatment with regard to the micro-, meso- and macro level? Which medical and organisational aspects that have an effect on the costs and/or cost-effectiveness have to be particularly taken into account with regard to pain treatment/chronic pain? What is the influence of the individual patient's needs (micro level) in different situations of pain (e. g. palliative situation) on the meso- and macro level? Which social-medical and ethical aspects for an adequate treatment of chronic pain on each level have to be specially taken into account? Is the consideration of these aspects appropriate to avoid over- or undertreatment? Are juridical questions included in every day care of chronic pain patients, mainly in palliative care? On which level can appropriate interventions prevent over- or undertreatment? Methods A systematic literature research is done in 35 databases. In the HTA, reviews, epidemiological and clinical studies and economic evaluations are included which report about pain therapy and in particular palliative care in the years 2005 till 2010. Results 47 studies meet the inclusion criteria. An undertreatment of acupuncture, over- and misuse with regard to opiate prescription and an overuse regarding unspecific chest pain and chronic low back pain (LBP) can be observed. The results show the benefit and the cost-effectiveness of interdisciplinary as well as multi-professional approaches, multimodal pain therapy and cross-sectoral integrated medical care. Only rough values can be determined about the care situation regarding the supply of pain therapeutic and palliative medical facilities as the data are completely insufficient. Discussion Due to the broad research question the HTA-report contains inevitably different outcomes and study designs which partially differ qualitatively very strong from each other. In the field of palliative care hospices for in-patients and palliative wards as well as hospices for out-patients are becoming more and more important. Palliative care is a basic right of all terminally ill persons. Conclusion Despite the relatively high number of studies in Germany the HTA-report shows a massive lack in health care research. Based on the studies a further expansion of out-patient pain and palliative care is recommended. Further training for all involved professional groups must be improved. An independent empirical analysis is necessary to determine over or undertreatment in pain care.
GMS Health Technology Assessment; 7:Doc03; ISSN 1861-8863
- GP Forschungsgruppe Germany
Schmerzzustände, TECHNOLOGY ASSESSMENT, BIOMEDICAL, Methodik, Nackenschmerz, models, economic, Meta-Analyse, Brustwirbelsäule, Kopfschmerz, supply shortage, Multizenter, randomisierte kontrollierte Studie, double-blind method, PEER REVIEW, KREUZSCHMERZEN, migraine, Ischialgie, ECONOMICS, MEDICAL, Effizienz, Schmerzversorgung, judgment, specifity, triple blind, Lebensqualität, integrated care, Frühberentung, einfach blind, HTA, Opiat, medizinische Versorgungskosten, pain reduction, lack of work, Diagnose, Rückenschmerz, juricical, palliative Behandlung, kontrollierte klinische Studien, medical evaluation, singleblind, sick certificate, CLINICAL TRIALS AS TOPIC, early retirement, methods, placebos, health care costs, prospektive Studien, single blind method, HTA report, SINGLE-BLIND METHOD, chronisch, Genauigkeitsstudie, MULTICENTER STUDIES AS TOPIC, somatoforme Störungen, health economic studies, DOPPELBLINDMETHODE, systematische Übersicht, MULTIZENTRISCHE STUDIEN, META-ANALYSIS AS TOPIC, Palliativmedizin, Schmerzmessung, meta analysis, evidence based medicine, MEDIZINISCHE VERSORGUNGSKOSTEN, costs, randomized controlled study, palliative medicine, randomised clinical trial, gesundheitsökonomische Studien, Methoden, cost-benefit analyses, cross-over trials, Fehlversorgung, doctor's note, Schmerzzentrum, cost effectiveness, HEALTH POLICY, Rehabilitation, Beurteilung, Verblindung, thoracic vertebral column, DELIVERY OF HEALTH CARE, health care, spondylosis, SCHMERZKLINIKEN, controlled clinical trials as topic, DOUBLE-BLIND METHOD, Kosten und Kostenanalyse, Kosten-Nutzen-Analyse, GESUNDHEITSPOLITIK, randomisierter Versuch, Rückenschmerzen, SHOULDER PAIN, review, trial, cross-over, effectiveness, socioeconomic factors, Prävention, Entscheidungsfindung, PLAZEBOS, VALIDIERUNGSSTUDIEN, Palliativversorgung, Schmerzen, ECONOMICS, Gesundheitsversorgung, cost-benefit analysis, MENSCH, PROSPECTIVE STUDIES, PLACEBO EFFECT, headache; health, meta-analysis, PROSPEKTIVE STUDIEN, evaluation studies as topic, Schmerzklinik, pain therapy, doubleblind, medizinische Beurteilung, PALLIATIVE CARE, doppel-blind, Wirbelsäulenleiden, prevention, cost analysis, Multicenter, cross-over studies, SOCIOECONOMIC FACTORS, risk assessment, Kosten, kontrollierte klinische Versuche, cost-cutting, HEALTH, cost reduction, COST-BENEFIT ANALYSIS, KOPFSCHMERZ, shoulder pain, sick note, single blind, Schmerzmanagement, rehabilitation, pain situation, Versorgung, blinding, program effectiveness, SCHULTERSCHMERZEN, DECISION MAKING, crossover, Cross-over-Studien, Technologiebewertung, Plazeboeffekt, technology assessment, Palliativpflege, economic aspect, Reha, ethics, randomised trial, psychotherapy, Schmerzpatient, HUMAN RIGHTS, METAANALYSE, pain care, Programmeffektivität, Kostenreduktion, Spondylose, Krankheitskosten, efficacy, neck pain, kontrollierte klinische Studie, Arbeitsausfall, Pharmaökonomie, multicenter, ENTSCHEIDUNGSFINDUNG, verblindeter Versuch, HTA-Bericht, Evaluation, cross-over, pain disorder, KOSTEN UND KOSTENANALYSE, controlled clinical study, TECHNOLOGIE, MEDIZINISCHE, palliative care, Modelle, ökonomische, treatment, HUMANS, somatoform disorders, medizinische Technologie, NECK PAIN, social economic factors, Recht, Wirbelsäule, ddc: 610, Schulterschmerzen, Gesundheitspolitik, Wirksamkeit, Schmerz, vertebral column, Gutachtenbasierte Medizin, Plazebos, Krankschreibung, Migräne, semiblinder Versuch, lumbar pain, overuse, ANALGESIE, pain measurement, dreifach verblindet, ANALGESIA, randomized clinical study, TECHNOLOGY, Überversorgung, medical assessment, spinal column, cross over; crossover, pain clinics, delivery of health care, double blind, Gesundheit, random, stoppage, klinische Studie, Versorgungsdefizit, ökonomischer Aspekt, pain patient, Palliativtherapie, CROSS-OVER-STUDIEN, Effektivität, SOMATOFORM DISORDERS, triple-blind, multicentre, underuse, Risikoabschätzung, verblindete Studie, HEADACHE, biomedical technology assessment, RISK ASSESSMENT, PAIN MEASUREMENT, Pflege, humans, report, Grundrecht, HEALTH CARE COSTS, Ökonomie, Versorgungskosten, Übersichtsliteratur, clinical trial, health policy, NACKENSCHMERZ, Rechte, hospice, technology, Hospiz, Kostensenkung, randomisierte kontrollierte Studien, LEBENSQUALITÄT, SOZIALÖKONOMISCHE FAKTOREN, Sozialmedizin, palliative therapy, randomisierte Zuordnung, einfach-blind, back pain, Akupunktur, Metaanalyse, SOMATOFORME STÖRUNGEN, Article, multizentrische Studien, Sterbebegleitung, Zufall, Behandlung, Technikfolgen-Abschätzung, biomedizinische, palliativ, health technology assessment, HTA-report, Einfachblindmethode, validation studies, Gesundheitsökonomie, Psychotherapie, randomized clinical trial, sensitivity, BACK PAIN, zweifach verblindet, TECHNOLOGIE, quality of life, MODELS, ECONOMIC, randomized controlled trial, life qualities, REVIEW LITERATURE AS TOPIC, KONTROLLIERTE KLINISCHE STUDIEN, Palliativpersonal, Arzneimittel, Lendenwirbelschmerzen, PLACEBOS, Peer review, sozioökonomische Faktoren, palliative, Schmerzambulanz, health economics, pain, integrierte Versorgung, sozialökonomische Faktoren, EbM, COSTS AND COST ANALYSIS, randomised controlled study, PAIN, palliative treatment, Schmerzkliniken, RANDOMISIERUNG, Sensitivität, chronic, randomised clinical study, RANDOM ALLOCATION, research article, Versorgungsangebot, technology evaluation, multimodales Versorgungsangebot, JUDGMENT, evidence-based medicine, RÜCKENSCHMERZEN, CT, sozio-ökonomische Faktoren, EFFICIENCY, EBM, TECHNIKFOLGEN-ABSCHÄTZUNG, BIOMEDIZINISCHE, Forschungsartikel, EVALUATION STUDIES AS TOPIC, Kreuzschmerzen, semiverblindeter Versuch, Placeboeffekt, costs and cost analysis, decision making, socioeconomics, QUALITY OF LIFE, Mensch, Evaluationsstudien, Sozioökonomie, care, ÖKONOMIE, ÄRZTLICHE, multimodal supply, cost control, therapy, semi-blinder Versuch, controlled clinical trial, Technologie, medizinische, economics, Analgetika, Schmerzzustand, CONTROLLED CLINICAL TRIALS AS TOPIC, pain management, placebo, research-article, random allocation, randomized study, Palliativpflegedienst, diagnosis, ÖKONOMIE, Technologie, misuse, Lendenwirbel, technology assessment, biomedical, Schmerzmedikament, multicenter trial, Kostenminimierung, PAIN CLINICS, healthcare needs, TECHNOLOGY, MEDICAL, low back pain, Vorsorge, single-blind, Health Technology Assessment, technical report, 610 Medical sciences; Medicine, Ökonomie, ärztliche, bedarfsgerechte Versorgung, KLINISCHE STUDIEN, MENSCHENRECHTE, evidenzbasierte Medizin, einfachblind, Gesundheitsfinanzierung, PLAZEBOEFFEKT, Plazebo, randomization, verblindet, medical costs, HTA Bericht, semi-verblindeter Versuch, trial, crossover, klinische Studien, sickness costs, randomisation, EINFACHBLINDMETHODE, thoracic spine, Analgesie, multimodal, PALLIATIVPFLEGE, doppelblind, accident, Medikamente, clinical study, Doppelblindmethode, doppel blind, prospective studies, CCT, peer review, rights, Schmerztherapie, randomised controlled trial, randomisierte klinische Studie, EVIDENCE-BASED MEDICINE, GESUNDHEITSVERSORGUNG, Randomisierung, pain clinic, systematic review, medizinische Bewertung, EVALUATIONSSTUDIEN, randomized trial, Sterben, EFFIZIENZ, Schmerzlinderung, technology, medical, RISIKOABSCHÄTZUNG, CROSS-OVER STUDIES, ischialgia, analgesia, chronischer Schmerz, Sterbende, Kosteneffektivität, Kosten-Effektivität, Schmerzstörung, Technologiebeurteilung, SCHMERZEN, BEURTEILUNG, Versorgungsalltag, economics, medical, randomisierte Studie, medical care, double-blind, Therapie, chronic pain, RCT, Krankmeldung, RANDOMIZED CONTROLLED TRIALS AS TOPIC, Ethik, ÜBERSICHTSLITERATUR, Validierungsstudien, KOSTEN-NUTZEN-ANALYSE, Unterversorgung, LOW BACK PAIN, palliative treatments, RANDOMISIERTE KONTROLLIERTE STUDIEN, Übersichtsarbeit, Spezifität, MODELLE, ÖKONOMISCHE, Verhaltenstherapie, SCHMERZMESSUNG, VALIDATION STUDIES AS TOPIC, Hospizdienst, cost-effectiveness, GUTACHTENBASIERTE MEDIZIN, GESUNDHEIT, Placebo, cross over, randomised study, review literature, blinded, pharmaeconomics, efficiency, placebo effect, Kostenkontrolle, tripleblind
Schmerzzustände, TECHNOLOGY ASSESSMENT, BIOMEDICAL, Methodik, Nackenschmerz, models, economic, Meta-Analyse, Brustwirbelsäule, Kopfschmerz, supply shortage, Multizenter, randomisierte kontrollierte Studie, double-blind method, PEER REVIEW, KREUZSCHMERZEN, migraine, Ischialgie, ECONOMICS, MEDICAL, Effizienz, Schmerzversorgung, judgment, specifity, triple blind, Lebensqualität, integrated care, Frühberentung, einfach blind, HTA, Opiat, medizinische Versorgungskosten, pain reduction, lack of work, Diagnose, Rückenschmerz, juricical, palliative Behandlung, kontrollierte klinische Studien, medical evaluation, singleblind, sick certificate, CLINICAL TRIALS AS TOPIC, early retirement, methods, placebos, health care costs, prospektive Studien, single blind method, HTA report, SINGLE-BLIND METHOD, chronisch, Genauigkeitsstudie, MULTICENTER STUDIES AS TOPIC, somatoforme Störungen, health economic studies, DOPPELBLINDMETHODE, systematische Übersicht, MULTIZENTRISCHE STUDIEN, META-ANALYSIS AS TOPIC, Palliativmedizin, Schmerzmessung, meta analysis, evidence based medicine, MEDIZINISCHE VERSORGUNGSKOSTEN, costs, randomized controlled study, palliative medicine, randomised clinical trial, gesundheitsökonomische Studien, Methoden, cost-benefit analyses, cross-over trials, Fehlversorgung, doctor's note, Schmerzzentrum, cost effectiveness, HEALTH POLICY, Rehabilitation, Beurteilung, Verblindung, thoracic vertebral column, DELIVERY OF HEALTH CARE, health care, spondylosis, SCHMERZKLINIKEN, controlled clinical trials as topic, DOUBLE-BLIND METHOD, Kosten und Kostenanalyse, Kosten-Nutzen-Analyse, GESUNDHEITSPOLITIK, randomisierter Versuch, Rückenschmerzen, SHOULDER PAIN, review, trial, cross-over, effectiveness, socioeconomic factors, Prävention, Entscheidungsfindung, PLAZEBOS, VALIDIERUNGSSTUDIEN, Palliativversorgung, Schmerzen, ECONOMICS, Gesundheitsversorgung, cost-benefit analysis, MENSCH, PROSPECTIVE STUDIES, PLACEBO EFFECT, headache; health, meta-analysis, PROSPEKTIVE STUDIEN, evaluation studies as topic, Schmerzklinik, pain therapy, doubleblind, medizinische Beurteilung, PALLIATIVE CARE, doppel-blind, Wirbelsäulenleiden, prevention, cost analysis, Multicenter, cross-over studies, SOCIOECONOMIC FACTORS, risk assessment, Kosten, kontrollierte klinische Versuche, cost-cutting, HEALTH, cost reduction, COST-BENEFIT ANALYSIS, KOPFSCHMERZ, shoulder pain, sick note, single blind, Schmerzmanagement, rehabilitation, pain situation, Versorgung, blinding, program effectiveness, SCHULTERSCHMERZEN, DECISION MAKING, crossover, Cross-over-Studien, Technologiebewertung, Plazeboeffekt, technology assessment, Palliativpflege, economic aspect, Reha, ethics, randomised trial, psychotherapy, Schmerzpatient, HUMAN RIGHTS, METAANALYSE, pain care, Programmeffektivität, Kostenreduktion, Spondylose, Krankheitskosten, efficacy, neck pain, kontrollierte klinische Studie, Arbeitsausfall, Pharmaökonomie, multicenter, ENTSCHEIDUNGSFINDUNG, verblindeter Versuch, HTA-Bericht, Evaluation, cross-over, pain disorder, KOSTEN UND KOSTENANALYSE, controlled clinical study, TECHNOLOGIE, MEDIZINISCHE, palliative care, Modelle, ökonomische, treatment, HUMANS, somatoform disorders, medizinische Technologie, NECK PAIN, social economic factors, Recht, Wirbelsäule, ddc: 610, Schulterschmerzen, Gesundheitspolitik, Wirksamkeit, Schmerz, vertebral column, Gutachtenbasierte Medizin, Plazebos, Krankschreibung, Migräne, semiblinder Versuch, lumbar pain, overuse, ANALGESIE, pain measurement, dreifach verblindet, ANALGESIA, randomized clinical study, TECHNOLOGY, Überversorgung, medical assessment, spinal column, cross over; crossover, pain clinics, delivery of health care, double blind, Gesundheit, random, stoppage, klinische Studie, Versorgungsdefizit, ökonomischer Aspekt, pain patient, Palliativtherapie, CROSS-OVER-STUDIEN, Effektivität, SOMATOFORM DISORDERS, triple-blind, multicentre, underuse, Risikoabschätzung, verblindete Studie, HEADACHE, biomedical technology assessment, RISK ASSESSMENT, PAIN MEASUREMENT, Pflege, humans, report, Grundrecht, HEALTH CARE COSTS, Ökonomie, Versorgungskosten, Übersichtsliteratur, clinical trial, health policy, NACKENSCHMERZ, Rechte, hospice, technology, Hospiz, Kostensenkung, randomisierte kontrollierte Studien, LEBENSQUALITÄT, SOZIALÖKONOMISCHE FAKTOREN, Sozialmedizin, palliative therapy, randomisierte Zuordnung, einfach-blind, back pain, Akupunktur, Metaanalyse, SOMATOFORME STÖRUNGEN, Article, multizentrische Studien, Sterbebegleitung, Zufall, Behandlung, Technikfolgen-Abschätzung, biomedizinische, palliativ, health technology assessment, HTA-report, Einfachblindmethode, validation studies, Gesundheitsökonomie, Psychotherapie, randomized clinical trial, sensitivity, BACK PAIN, zweifach verblindet, TECHNOLOGIE, quality of life, MODELS, ECONOMIC, randomized controlled trial, life qualities, REVIEW LITERATURE AS TOPIC, KONTROLLIERTE KLINISCHE STUDIEN, Palliativpersonal, Arzneimittel, Lendenwirbelschmerzen, PLACEBOS, Peer review, sozioökonomische Faktoren, palliative, Schmerzambulanz, health economics, pain, integrierte Versorgung, sozialökonomische Faktoren, EbM, COSTS AND COST ANALYSIS, randomised controlled study, PAIN, palliative treatment, Schmerzkliniken, RANDOMISIERUNG, Sensitivität, chronic, randomised clinical study, RANDOM ALLOCATION, research article, Versorgungsangebot, technology evaluation, multimodales Versorgungsangebot, JUDGMENT, evidence-based medicine, RÜCKENSCHMERZEN, CT, sozio-ökonomische Faktoren, EFFICIENCY, EBM, TECHNIKFOLGEN-ABSCHÄTZUNG, BIOMEDIZINISCHE, Forschungsartikel, EVALUATION STUDIES AS TOPIC, Kreuzschmerzen, semiverblindeter Versuch, Placeboeffekt, costs and cost analysis, decision making, socioeconomics, QUALITY OF LIFE, Mensch, Evaluationsstudien, Sozioökonomie, care, ÖKONOMIE, ÄRZTLICHE, multimodal supply, cost control, therapy, semi-blinder Versuch, controlled clinical trial, Technologie, medizinische, economics, Analgetika, Schmerzzustand, CONTROLLED CLINICAL TRIALS AS TOPIC, pain management, placebo, research-article, random allocation, randomized study, Palliativpflegedienst, diagnosis, ÖKONOMIE, Technologie, misuse, Lendenwirbel, technology assessment, biomedical, Schmerzmedikament, multicenter trial, Kostenminimierung, PAIN CLINICS, healthcare needs, TECHNOLOGY, MEDICAL, low back pain, Vorsorge, single-blind, Health Technology Assessment, technical report, 610 Medical sciences; Medicine, Ökonomie, ärztliche, bedarfsgerechte Versorgung, KLINISCHE STUDIEN, MENSCHENRECHTE, evidenzbasierte Medizin, einfachblind, Gesundheitsfinanzierung, PLAZEBOEFFEKT, Plazebo, randomization, verblindet, medical costs, HTA Bericht, semi-verblindeter Versuch, trial, crossover, klinische Studien, sickness costs, randomisation, EINFACHBLINDMETHODE, thoracic spine, Analgesie, multimodal, PALLIATIVPFLEGE, doppelblind, accident, Medikamente, clinical study, Doppelblindmethode, doppel blind, prospective studies, CCT, peer review, rights, Schmerztherapie, randomised controlled trial, randomisierte klinische Studie, EVIDENCE-BASED MEDICINE, GESUNDHEITSVERSORGUNG, Randomisierung, pain clinic, systematic review, medizinische Bewertung, EVALUATIONSSTUDIEN, randomized trial, Sterben, EFFIZIENZ, Schmerzlinderung, technology, medical, RISIKOABSCHÄTZUNG, CROSS-OVER STUDIES, ischialgia, analgesia, chronischer Schmerz, Sterbende, Kosteneffektivität, Kosten-Effektivität, Schmerzstörung, Technologiebeurteilung, SCHMERZEN, BEURTEILUNG, Versorgungsalltag, economics, medical, randomisierte Studie, medical care, double-blind, Therapie, chronic pain, RCT, Krankmeldung, RANDOMIZED CONTROLLED TRIALS AS TOPIC, Ethik, ÜBERSICHTSLITERATUR, Validierungsstudien, KOSTEN-NUTZEN-ANALYSE, Unterversorgung, LOW BACK PAIN, palliative treatments, RANDOMISIERTE KONTROLLIERTE STUDIEN, Übersichtsarbeit, Spezifität, MODELLE, ÖKONOMISCHE, Verhaltenstherapie, SCHMERZMESSUNG, VALIDATION STUDIES AS TOPIC, Hospizdienst, cost-effectiveness, GUTACHTENBASIERTE MEDIZIN, GESUNDHEIT, Placebo, cross over, randomised study, review literature, blinded, pharmaeconomics, efficiency, placebo effect, Kostenkontrolle, tripleblind
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