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Over-, under- and misuse of pain treatment in Germany

Author(s): Dietl, Markus | Korczak, Dieter

Journal: GMS Health Technology Assessment
ISSN 1861-8863

Volume: 7;
Start page: Doc03;
Date: 2011;
Original page

Keywords: accident | analgesia | back pain | biomedical technology assessment | blinded | blinding | care | chronic | chronic pain | clinical study | clinical trial | controlled clinical study | controlled clinical trial | controlled clinical trials as topic | cost analysis | cost control | cost effectiveness | cost reduction | cost-benefit analyses | cost-benefit analysis | cost-cutting | cost-effectiveness | costs | costs and cost analysis | cross over | crossover | cross-over | cross-over studies | cross-over trials | decision making | delivery of health care | diagnosis | doctor's note | double blind | doubleblind | double-blind | double-blind method | early retirement | EBM | economic aspect | economics | economics | medical | effectiveness | efficacy | efficiency | ethics | evaluation studies as topic | evidence based medicine | evidence-based medicine | headache | health | health care | health care costs | health economic studies | health economics | health policy | health technology assessment | healthcare needs | hospice | HTA | HTA report | HTA-report | humans | integrated care | ischialgia | judgment | juricical | lack of work | life qualities | low back pain | lumbar pain | medical assessment | medical care | medical costs | medical evaluation | meta analysis | meta-analysis | methods | migraine | misuse | models | economic | multicenter | multicenter trial | multicentre | multimodal supply | neck pain | overuse | pain | pain care | pain clinic | pain clinics | pain disorder | pain management | pain measurement | pain patient | pain reduction | pain situation | pain therapy | palliative | palliative care | palliative medicine | palliative therapy | palliative treatment | palliative treatments | peer review | pharmaeconomics | placebo | placebo effect | placebos | prevention | program effectiveness | prospective studies | psychotherapy | quality of life | random | random allocation | randomisation | randomised clinical study | randomised clinical trial | randomised controlled study | randomised controlled trial | randomised study | randomised trial | randomization | randomized clinical study | randomized clinical trial | randomized controlled study | randomized controlled trial | randomized study | randomized trial | RCT | rehabilitation | report | research article | research-article | review | review literature | rights | risk assessment | sensitivity | shoulder pain | sick certificate | sick note | sickness costs | single blind | single blind method | singleblind | single-blind | social economic factors | socioeconomic factors | socioeconomics | somatoform disorders | specifity | spinal column | spondylosis | stoppage | supply shortage | systematic review | technical report | technology | technology assessment | technology assessment | biomedical | technology evaluation | technology | medical | therapy | thoracic spine | thoracic vertebral column | treatment | trial | crossover | trial | cross-over | triple blind | tripleblind | triple-blind | underuse | validation studies | vertebral column

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.
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