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]

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