10.3205/HTA000094
Dietl, Markus
Markus
Dietl
Korczak, Dieter
Dieter
Korczak
Over-, under- and misuse of pain treatment in Germany
German Medical Science GMS Publishing House
2011
JournalArticle
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
610 Medical sciences; Medicine
2011-04-19
2011
en
urn:nbn:de:0183-hta0000944
hta000094
text/html
GMS Health Technology Assessment; 7:Doc03; ISSN 1861-8863
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