Leitlinien zur Schmerztherapie

Abstract

The committee for quality assurance of the German IASP chapter (DGSS) evaluated all relevant guidelines concerning pain treatment. Quality of guidelines was analysed according to the checklist "Methodical quality of guidelines" by Ollenschläger and the user manual released by the German Medical Centre for Quality Assurance. The guideline for the treatment of back pain released by the German Medical Association was examined as well as the one released by the German Association for physical therapy and rehabilitation, the guideline on cervical and lumbal nerve root compression syndrome of the German Association of Neurosurgeons, the guideline for cancer pain of the Drug Committee of the German Medical Association was compared with the one of the German Interdisciplinary Association for Pain Treatment. The guideline for the treatment of chronic headache and facial pain of the Medical Association was evaluated and the guideline for the treatment of trigeminal neuralgia of the German Association of Neurosurgery and Neurology, also the guideline for the treatment of acute postoperative and posttraumatic pain. All guidelines show deficiencies in different aspects and of different severity. At first there are deficiencies in interdisciplinary formulation of the guidelines and identification and interpretation of evidence of multimodal pain treatment options. The most prominent deficiency is the lack of implementation and application trials or impulses by all author associations. This way all expenditure on releasing guidelines is given away without improving quality of pain treatment. The authors' recommendation is to adjust to guidelines and, if they are working or not, tell the authors and improve interdisciplinary in pain treatment guidelines.

Inanspruchnahme von medizinischen Leistungen bei Schmerzpatienten unter Opioid-Therapie in der ambulanten Versorgung

“…Opioide der Stufe 3 werden in Deutschland in der Regel nur ü ber einen kurzen Therapiezeitraum gegeben [11] . Die Qualit ä tssicherungskommission der Deutschen Gesellschaft zum Studium des Schmerzes stellte erhebliche M ä ngel bei den deutschen Schmerztherapie-Leitlinien fest [12] . Zu einem ä hnlichem Ergebnis kommt der Leitlinien-Clearingbericht " chronischer R ü ckenschmerz " , in dem eine Unterversorgung mit Opioiden festgestellt und eine Ber ü cksichtigung des WHO-Stufenschemas empfohlen wird [13] .…”