Algesiologie Trend 2008

Trends in pain therapy in Germany from Jan. 2006:

Research

·  Most research findings in medicine are false [Ioannidis 2005]
·  Medicine didn’t prevent the increase in chronic diseases
·  EbM should change paradigm toward humans [Wehkamp 2006]
·  But Medical Universities didn’t add TCM curriculum courses [Study]
·  Today’s medicine can only treat a disease after symptoms occured
·  Approbation Guide: Teach Complementary Medicine [ÄappO]
·  System-theoretic medicine: Results must improve life quality
·  Chronical pain often gets learned, it has a pain memory
·  Patients feel pain levels subjective, its range varies broadly

Public Health

·  Gesundheitsministerium has no dedicated objectives [SVR-G 2007]
·  Chronical Pains are the health disorders with the highest costs
·  EbM system is totally not adapted to chronic diseases [AHG 2000]
·  Expenses for pharmaceuticals higher as for physicians [Grill 2007]
·  Mass syndrome: 1,9 Million Germans are drug addicted [DHS 2006]
·  Expenses for physical diseases account for 22 bn EUR per year
·  Comprehensive care for chronical pain patents [§135 Abs.2 SGB V]
·  Quality Institute evaluates cost-benefit of therapies [IQWiG 2007]
·  ‘Spitzenverbände der Kassen’ have QM-responability [GSG 2004]
·  The pop declared: Therapy is ok, nobody should suffer from pain

Health Care

·  Structural change lets immaterial healthcare services grow fast
·  4.3 mill employees in Healthcare Germany [IAB 2007]
·  0.7 mill employees in Nursing, 0.25 mill in Geriatric Nursing [ICN]
·  Nursing includes health stimulation and disease prevention [ICN]

Physicians

·  Physicians became the administrators of patients [König 2007]
·  Disease & Case Management require interdisciplinary collaboration
·  Disease Management should treat similar chronical diseases
·  Family physicians strengthened as transfer agent to med. specialists
·  96% medical students want to be active curative [Pichlmayr 2007]

Diseases

·  50% of EU and German adults have chronic pain [PAIN 2005]
·  1.3 mill. Germans have chronical pains that would require opiate
·  1 mill. of them do not get an adequate medication or therapy
·  Disease/yr: 1. Heart-Circulation 2. Cancer 390.000 [RKI 2006]

Patients

·  Many of the ~500 disease self-help organizations are associations 
·  DGS and DGSS published the ‘Deutscher Schmerz-Fragebogen’
·  In the questionnaire a patient defines the individual therapy goal
·  82% of patients are not satisfied with a pain release of 50%

Pain Therapy

·  ‘Spezielle Schmerztherapie’ treats the symptom instead of the cause
·  Patients do pain tourism for 10 years with 8 med. specialists [Study]
·  30% of stationary pain operations has been unsuccessful
·  ENRAC Success: 70% regional pain cases solved in first treatment
·  There is no method that can quantify the pain level correctly
·  Study shows that doctors estimate only 20% of pain levels correctly
·  In major cities larger hospitals built an interdisciplinary pain center

Summary

·  The health system of Germany is responsible for 50% chronicity
·  The situation of pain patients in Germany has been disastrous
·  Life improvement comes from immaterial health care services
[Markus Grill, Kranke Geschäfte, ISBN 3498025090, 2007]