20 results on '"Kristin Kieselbach"'
Search Results
2. Chronic pain as an existential challenge
- Author
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Kristin Kieselbach, Dominik Koesling, Thomas Wabel, Ursula Frede, and Claudia Bozzaro
- Subjects
Anesthesiology and Pain Medicine ,Neurology (clinical) - Abstract
ZusammenfassungDas biopsychosoziale Schmerzkonzept stellt gegenwärtig den Schwerpunkt schmerztherapeutischer Behandlungsprogramme dar. Jedoch kann damit die Komplexität chronischer Schmerzen, insbesondere ihre Bedeutung für die Betroffenen, nur unzureichend erfasst werden. Denn ein Kernaspekt des Phänomens chronischer Schmerz wird bislang nur in Einzelfällen berücksichtigt: sein existenzieller Charakter. Chronische Schmerzen können das Selbst- und Weltverständnis, die Lebenswünsche und -ziele, letztlich die gesamte Integrität der Betroffenen bedrohen. Selbstaussagen Erkrankter zeigen, dass chronischer Schmerz immer ein existenzielles Widerfahrnis darstellt und den Menschen in seiner Gesamtheit erfasst. Dies wird durch zwei Aspekte deutlich: zum einen durch die existenzielle Verzweiflung am Schmerz, zum anderen durch Fragen der Sinngebung und Neuorientierung. Allerdings berücksichtigen gängige Therapiekonzepte den existenziellen Charakter mit derartigen Herausforderungen bislang nicht adäquat. Chronischer Schmerz sollte daher stets unter einer umfassenden Perspektive wahrgenommen und behandelt werden. Hierbei sind die Aspekte Einzigartigkeit anerkennen, zum Ausdruck verhelfen und dem Er-leben Raum geben zur Unterstützung Erkrankter in ihrer Auseinandersetzung mit dem Schmerz besonders zu berücksichtigen.
- Published
- 2022
- Full Text
- View/download PDF
3. Nicht-indikationsgemäßer Einsatz schnell freisetzender Fentanylzubereitungen
- Author
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Michael Schenk, Marco Cascella, H. Hofbauer, Kristin Kieselbach, Stefan Wirz, H. C. Wartenberg, Anesthesiology, and ACS - Heart failure & arrhythmias
- Subjects
Gynecology ,Prescription behaviour ,medicine.medical_specialty ,business.industry ,Fentanyl ,03 medical and health sciences ,Opioid misuse ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,medicine ,Neurology (clinical) ,Cancer pain ,business ,Opioid-induced adverse effects ,030217 neurology & neurosurgery - Abstract
Die Datenlage zur nicht-indikationsgemasen Verschreibung schnell freisetzender Fentanylformulierungen (SFF) bei Nicht-Tumorschmerz (NTS) ist unzureichend, obwohl entsprechende Hinweise und Warnungen vorliegen. Auf Initiative des Arbeitskreises Tumorschmerz wurde mit Unterstutzung der Deutschen Schmerzgesellschaft e. V. eine stichprobenartige Fragebogenerfassung der nicht-indikationsgemasen Anwendung von SFF durchgefuhrt. Die Befragung richtete sich an Teilnehmer von schmerzmedizinischen Fortbildungen mit der Moglichkeit, den Fragebogen auserhalb davon bzw. online zu bearbeiten. In dem strukturierten Fragebogen wurden als primarer Endpunkt quantitative und qualitative Daten zur Verschreibung von SFF erhoben, als sekundare Endpunkte opioidtypische Nebenwirkungen. Bei einer Rucklaufquote von 44 % (132/300) und 51 online ausgefullten Fragebogen waren nicht-indizierte Verschreibungen bei 165 (90 %) der Befragten bekannt bzw. waren diese in der Behandlung involviert. 65 % waren in der Klinik und 17 % ambulant tatig; 22 % wiesen die Weiterbildung Schmerz- oder Palliativmedizin auf. Schatzungsweise wurden indirekt 1205 Patienten erfasst. Als Einsatzgrunde wurden hauptsachlich Wirbelsaulenschmerzen (44 %), neuropathische Schmerzen (33 %), Kopf- und Gesichtsschmerzen (12 %) bei NTS angegeben, bei Tumorpatienten die auserhalb der Indikation liegende Dyspnoe (5 %) und das Nichtvorliegen der Indikation Durchbruchschmerz bzw. das Fehlen einer Basismedikation (44 %). Sedierung (32 %), Ubelkeit/Erbrechen (31 %), Obstipation (16 %) und unzureichende Analgesie (31 %) waren die am haufigsten benannten unerwunschten Wirkungen. Trotz eindeutiger Indikationen der SFF weichen Arzte haufig von einem sachgerechten Verschreibungsverhalten ab. Die Rate iatrogener Fehlanwendungen sollte minimiert werden. Nebenwirkungen von SSF scheinen denen anderer Opioidzubereitungen zu entsprechen.
- Published
- 2020
- Full Text
- View/download PDF
4. [Adverse effects of opioids, antidepressants and anticonvulsants on sex hormones : Often unnoticed but clinically relevant]
- Author
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Stefan, Wirz, Michael, Schenk, and Kristin, Kieselbach
- Subjects
Analgesics, Opioid ,Chronic Disease ,Androgens ,Quality of Life ,Humans ,Anticonvulsants ,Chronic Pain ,Gonadal Steroid Hormones ,Antidepressive Agents - Abstract
Androgen insufficiency under treatment with opioids, antidepressants and anticonvulsants in chronic pain diseases is a side effect with a high prevalence. It can lead to clinical metabolic alterations, adynamia, stress intolerance, anemia or osteoporosis and has a significant impact on the quality of life. Opioids, antidepressants and anticonvulsants affect the hypothalamic-pituitary-gonadal axis of sex hormones. A urologist, andrologist or endocrinologist should be involved in the treatment at an early stage. The recommendation of a differential therapeutic selection of certain substances is only indicative and does not meet evidential criteria. The indications for androgen substitution must be individualized and in consideration of the risk-benefit profile. Awareness of this side effect of an otherwise lege artis medicinal pain therapy must be sharpened and compulsory included in the differential diagnostic considerations.Eine Androgeninsuffizienz unter Therapie mit Opioiden, Antidepressiva und Antikonvulsiva bei chronischer Schmerzerkrankung ist eine Nebenwirkung mit hoher Prävalenz. Sie kann zu klinisch-metabolischen Veränderungen, Adynamie, Stressintoleranz, Anämie oder Osteoporose führen und hat erhebliche Auswirkungen auf die Lebensqualität. Opioide, Antidepressiva und Antikonvulsiva beeinträchtigen die Hypothalamus-Hypophysen-Gonaden-Achse von Sexualhormonen. Frühzeitig ist eine Urolog*in, Androlog*in bzw. Endokrinolog*in in die Behandlung zu involvieren. Die Empfehlung einer differenzialtherapeutischen Auswahl bestimmter Substanzen hat lediglich Hinweischarakter und entspricht nicht Evidenzkriterien. Die Indikation einer Androgensubstitution erfolgt individuell und in Abwägung von Nutzen und Risiken. Die Aufmerksamkeit für diese Nebenwirkung bei ansonsten lege artis durchgeführter medikamentöser Schmertherapie muss geschärft werden und zwingend in die Differenzialdiagnostik einbezogen werden.
- Published
- 2022
5. Minimally invasive surgery for spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension
- Author
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Jürgen Beck, Ulrich Hubbe, Jan-Helge Klingler, Roland Roelz, Luisa Mona Kraus, Florian Volz, Niklas Lützen, Horst Urbach, Kristin Kieselbach, and Christian Fung
- Subjects
General Medicine - Abstract
OBJECTIVE Spinal CSF leaks cause spontaneous intracranial hypotension (SIH). Surgical closure of spinal CSF leaks is the treatment of choice for persisting leaks. Surgical approaches vary, and there are no studies in which minimally invasive techniques were used. In this study, the authors aimed to detail the safety and feasibility of minimally invasive microsurgical sealing of spinal CSF leaks using nonexpandable tubular retractors. METHODS Consecutive patients with SIH and a confirmed spinal CSF leak treated at a single institution between April 2019 and December 2020 were included in the study. Surgery was performed via a dorsal 2.5-cm skin incision using nonexpandable tubular retractors and a tailored interlaminar fenestration and, if needed, a transdural approach. The primary outcome was successful sealing of the dura, and the secondary outcome was the occurrence of complications. RESULTS Fifty-eight patients, 65.5% of whom were female (median age 46 years [IQR 36–55 years]), with 38 ventral leaks, 17 lateral leaks, and 2 CSF venous fistulas were included. In 56 (96.6%) patients, the leak could be closed, and in 2 (3.4%) patients the leak was missed because of misinterpretation of the imaging studies. One of these patients underwent successful reoperation, and the other patient decided to undergo surgery at another institution. Two other patients had to undergo reoperation because of insufficient closure and a persisting leak. The rate of permanent neurological deficit was 1.7%, the revision rate for a persisting or recurring leak was 3.4%, and the overall revision rate was 10.3%. The rate of successful sealing during the primary closure attempt was 96.6% and 3.4% patients needed a secondary attempt. Clinical short-term outcome at discharge was unchanged in 14 patients and improved in 25 patients, and 19 patients had signs of rebound intracranial hypertension. CONCLUSIONS Minimally invasive surgery with tubular retractors and a tailored interlaminar fenestration and, if needed, a transdural approach is safe and effective for the treatment of spinal CSF leaks. The authors suggest performing a minimally invasive closure of spinal CSF leaks in specialized centers.
- Published
- 2022
6. Schmerztherapeutische Aspekte bei Tumoroperationen
- Author
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Stefan Wirz, Michael Schenk, and Kristin Kieselbach
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Treatment outcome ,Regional anaesthesia ,General Medicine ,Neoplasms surgery ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,Emergency Medicine ,medicine ,business ,030217 neurology & neurosurgery ,Tumor pain - Abstract
ZusammenfassungTrotz einer Vielzahl von Therapieoptionen wird die Akutschmerztherapie nach onkologischen Operationen häufig als unzureichend beschrieben. Neben einer unzureichenden Akutschmerztherapie können weitere Faktoren eine Hypersensitivierung und Chronifizierung sowie den Verlauf der Tumorerkrankung beeinflussen. Dieser Beitrag erklärt pathophysiologische Hintergründe und erläutert geeignete Therapiemodalitäten.
- Published
- 2019
- Full Text
- View/download PDF
7. Chronischer Schmerz und Gesellschaft
- Author
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Claudia Bozzaro, Dominik Koesling, and Kristin Kieselbach
- Subjects
Interpretation (philosophy) ,Perspective (graphical) ,Chronic pain ,Societal impact of nanotechnology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,Order (exchange) ,Economic cost ,medicine ,Normative ,Neurology (clinical) ,Sociological imagination ,Sociology ,Positive economics ,030217 neurology & neurosurgery - Abstract
The current debate about the interconnection between chronic pain and society is economically narrowed. This involves the threat of losing sight of the fact that the interconnection between society and chronic pain is a complex entanglement that goes beyond economic costs. This article addresses the mentioned entanglement by acknowledging the following four levels of society: (1) the social structure, (2) the way of life, with special reference to occupation and its counterpart, leisure time, (3) the (normative) interpretation patterns of chronic pain and (4) the treatment situation. The applied sociological perspective shows that society, and this also includes medicine, is more than a mere addressee of problems. Society has to be considered as an influencing factor with respect to the development and stabilization of chronic pain. The outlined broadening of the perspective should contribute to a better understanding of the societal impact on chronic pain in order to stimulate an improvement in care and possibly a long-term reduction in costs.
- Published
- 2019
- Full Text
- View/download PDF
8. [Chronic pain as an existential challenge]
- Author
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Kristin, Kieselbach, Dominik, Koesling, Thomas, Wabel, Ursula, Frede, and Claudia, Bozzaro
- Abstract
There is currently an emphasis on the biopsychosocial concept of pain in pain therapy programs. However, the complexity of chronic pain, in particular its importance for those affected by it, can only be insufficiently captured with this concept. This is due to the fact that, to date, one core aspect of the phenomenon chronic pain has only rarely been taken into account: its existential character. Chronic pain can threaten the self-image and the individual's understanding of the world, their wishes and goals in life, and ultimately the entire integrity of those affected. Statements by chronic pain sufferers show that such pain always represents an existential experience and affects the person as a whole. Two aspects make this very clear: the existential despair of the pain on the one hand, as well as questions of meaning and reorientation on the other. Current treatment concepts, however, do not adequately consider the existential character of such challenges. Chronic pain should therefore always be perceived and treated from a holistic perspective. In this context, the aspects of recognizing its uniqueness, helping to express the pain and giving space to the experience are to be given special consideration in order to support chronic pain patients in dealing with their pain.Das biopsychosoziale Schmerzkonzept stellt gegenwärtig den Schwerpunkt schmerztherapeutischer Behandlungsprogramme dar. Jedoch kann damit die Komplexität chronischer Schmerzen, insbesondere ihre Bedeutung für die Betroffenen, nur unzureichend erfasst werden. Denn ein Kernaspekt des Phänomens chronischer Schmerz wird bislang nur in Einzelfällen berücksichtigt: sein existenzieller Charakter. Chronische Schmerzen können das Selbst- und Weltverständnis, die Lebenswünsche und -ziele, letztlich die gesamte Integrität der Betroffenen bedrohen. Selbstaussagen Erkrankter zeigen, dass chronischer Schmerz immer ein existenzielles Widerfahrnis darstellt und den Menschen in seiner Gesamtheit erfasst. Dies wird durch zwei Aspekte deutlich: zum einen durch die existenzielle Verzweiflung am Schmerz, zum anderen durch Fragen der Sinngebung und Neuorientierung. Allerdings berücksichtigen gängige Therapiekonzepte den existenziellen Charakter mit derartigen Herausforderungen bislang nicht adäquat. Chronischer Schmerz sollte daher stets unter einer umfassenden Perspektive wahrgenommen und behandelt werden. Hierbei sind die Aspekte Einzigartigkeit anerkennen, zum Ausdruck verhelfen und dem Er-leben Raum geben zur Unterstützung Erkrankter in ihrer Auseinandersetzung mit dem Schmerz besonders zu berücksichtigen.
- Published
- 2021
9. Patients with Chronic Pain Prefer Maintenance of Pain Treatment Despite COVID-19 Pandemic Restrictions
- Author
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Barbara, Kleinmann, Birgit, Abberger, Kristin, Kieselbach, and Tilman, Wolter
- Subjects
Adult ,Male ,Depression ,SARS-CoV-2 ,COVID-19 ,Patient Preference ,Anxiety ,Middle Aged ,Surveys and Questionnaires ,Humans ,Pain Management ,Female ,Prospective Studies ,Chronic Pain - Abstract
Worldwide, the COVID-19 pandemic has a significant impact on daily life. First studies describe a negative impact of pandemic stressors even on individuals without previous mental illnesses. The home lockdown and the shutdown of pain clinics make it difficult for all patients to get the healthcare they need.The aim of this study was to investigate to what extent patients with chronic pain felt affected by the pandemic and its consequences on pain treatments, focussing on the beginning of the outbreak.A prospective noninterventional study.Medical University Center .One-hundred and forty-nine patients, suffering from chronic pain, treated at a large German interdisciplinary pain center, were studied over a period of 2 months at the beginning of the pandemic. Data from patient charts and questionnaires were evaluated. Patients were asked about postponements or cancellations of pain therapy, the possible effect on pain levels, depression, anxiety and stress, and the impact of intensified hygiene measures. Results were compared to those from standardized and validated questionnaires from the same patients (German version of the depression, anxiety, and stress scale = DASS) at the time of the first contact in the pain clinic.Eighty-four (56.4%) patients reported cancelled or postponed treatments during the pandemic. Those chronic pain patients with delayed or cancelled treatments reported significantly more pain and psychological distress. The delay or discontinuation of treatments resulted in a deterioration of symptoms. From the patients' point of view this deterioration was unrelated to the timing of treatment and not secondary to increased hygiene measures. In both groups, patients showed a significant amelioration of the DASS values compared to the values they had at the beginning of treatment, despite the negative effects of the COVID-19 pandemic on care structures. The majority of the patients do not think that the quality of pain treatment was significantly affected by the intensified hygiene requirements.The limitations of the study are the small number of patients because of the limitation to a short period of time at the beginning of the pandemic and the return rate of 40.2% of the study consents.Even in the event of a pandemic-related restriction of the care structures, patients with chronic pain benefit from pain therapy. Limitations such as the increased hygiene measures caused by the pandemic were not considered detrimental to the therapeutic measures.
- Published
- 2021
10. [Use of rapid-onset fentanyl preparations beyond indication : A random questionnaire survey among congress participants and pain physicians]
- Author
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Stefan, Wirz, Michael, Schenk, Hannes, Hofbauer, Hans-Christian, Wartenberg, Marco, Cascella, and Kristin, Kieselbach
- Subjects
Analgesics, Opioid ,Fentanyl ,Physicians ,Surveys and Questionnaires ,Humans ,Cancer Pain - Abstract
Despite publicised advice and warnings, there are only scant data on the non-indicated prescription of rapid-onset preparations of fentanyl (ROF) in non-cancer pain (NCP). Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation.Initiated by the Working Group Cancer Pain and supported by the German Pain Society, a random sample survey was conducted to assess the non-indicated use of ROF.The survey addressed attendees of pain conferences who were given the option to fill in the questionnaires outside the conference or online. Primary endpoints of the structured questionnaire were quantitative and qualitative items with regard to the prescription of ROF, while secondary endpoints were opioid-induced side effects.Obtaining a response rate of 44% (132/300) and an additional 51 online questionnaires revealed that 165 (90%) respondents had knowledge of non-indicated prescriptions or were involved in these. Of these, 65% were clinicians and 17% worked in an outpatient capacity. In all, 22% were trained pain or palliative physicians. Approximately 1205 patients were assessed indirectly. The main causes for dispensing ROF included NCP entities such as back pain (44%), neuropathic pain (33%), head or facial pain (12%), and dyspnea (5%) in cancer pain or lack of break-through pain or basic medication (44%). Sedation (32%), nausea/vomiting (31%), constipation (16%) and insufficient analgesia (31%) were the mostly commonly reported adverse effects.Despite the non-ambiguous indication for ROF, physicians often demonstrate inappropriate prescription behaviour. Iatrogenic misuse of ROF should be minimized. The rates of adverse effects of ROF seems to be in line with other opioids.HINTERGRUND: Die Datenlage zur nicht-indikationsgemäßen Verschreibung schnell freisetzender Fentanylformulierungen (SFF) bei Nicht-Tumorschmerz (NTS) ist unzureichend, obwohl entsprechende Hinweise und Warnungen vorliegen. ZIEL: Auf Initiative des Arbeitskreises Tumorschmerz wurde mit Unterstützung der Deutschen Schmerzgesellschaft e. V. eine stichprobenartige Fragebogenerfassung der nicht-indikationsgemäßen Anwendung von SFF durchgeführt.Die Befragung richtete sich an Teilnehmer von schmerzmedizinischen Fortbildungen mit der Möglichkeit, den Fragebogen außerhalb davon bzw. online zu bearbeiten. In dem strukturierten Fragebogen wurden als primärer Endpunkt quantitative und qualitative Daten zur Verschreibung von SFF erhoben, als sekundäre Endpunkte opioidtypische Nebenwirkungen.Bei einer Rücklaufquote von 44 % (132/300) und 51 online ausgefüllten Fragebögen waren nicht-indizierte Verschreibungen bei 165 (90 %) der Befragten bekannt bzw. waren diese in der Behandlung involviert. 65 % waren in der Klinik und 17 % ambulant tätig; 22 % wiesen die Weiterbildung Schmerz- oder Palliativmedizin auf. Schätzungsweise wurden indirekt 1205 Patienten erfasst. Als Einsatzgründe wurden hauptsächlich Wirbelsäulenschmerzen (44 %), neuropathische Schmerzen (33 %), Kopf- und Gesichtsschmerzen (12 %) bei NTS angegeben, bei Tumorpatienten die außerhalb der Indikation liegende Dyspnoe (5 %) und das Nichtvorliegen der Indikation Durchbruchschmerz bzw. das Fehlen einer Basismedikation (44 %). Sedierung (32 %), Übelkeit/Erbrechen (31 %), Obstipation (16 %) und unzureichende Analgesie (31 %) waren die am häufigsten benannten unerwünschten Wirkungen.Trotz eindeutiger Indikationen der SFF weichen Ärzte häufig von einem sachgerechten Verschreibungsverhalten ab. Die Rate iatrogener Fehlanwendungen sollte minimiert werden. Nebenwirkungen von SSF scheinen denen anderer Opioidzubereitungen zu entsprechen.
- Published
- 2020
11. Multimodale Schmerztherapie : Ein Praxislehrbuch
- Author
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Kristin Kieselbach, Stefan Wirz, Michael Schenk, Kristin Kieselbach, Stefan Wirz, and Michael Schenk
- Abstract
Chronische Schmerzen und ihre Behandlung stellen für die Betroffenen eine beträchtliche Belastung und für das Gesundheitssystem eine enorme Herausforderung dar. In diesem Praxislehrbuch wird die Behandlung chronisch Schmerzkranker, bei denen Schmerz einen eigenständigen Krankheitswert erlangt hat, fokussiert und somit dem vielschichtigen Behandlungskonzept der multimodalen Schmerztherapie erstmals ausreichend Rechnung getragen. Es bildet die gesamte Bandbreite der interdisziplinären/interprofessionellen multimodalen Schmerztherapie ab: So werden nicht nur Ursachen, Entstehung, Symptomatologie, Diagnostik und Therapieverfahren chronischer Schmerzen dargestellt, sondern auch das gesamte Spektrum der beteiligten unterschiedlichsten Fachbereiche samt ihres gemeinsamen Vorgehens und der ökonomischen und organisatorischen Rahmenbedingungen.
- Published
- 2021
12. Wenn Tumorschmerzen chronisch werden
- Author
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Kristin Kieselbach, H. Hofbauer, Michael Schenk, and Stefan Wirz
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,General Medicine ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,business ,Cancer pain ,Psychosocial ,030217 neurology & neurosurgery ,Sensitization ,Tumor pain - Abstract
Immer mehr Tumorpatienten leiden an chronischen Schmerzen. Arzte sollten deshalb nach Risikofaktoren einer Chronifizierung bei onkologischen Patienten fahnden und entsprechend fruhzeitig darauf reagieren.
- Published
- 2017
- Full Text
- View/download PDF
13. [Chronic pain and society : Sociological analysis of a complex interconnection]
- Author
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Dominik, Koesling, Kristin, Kieselbach, and Claudia, Bozzaro
- Subjects
Humans ,Chronic Pain - Abstract
The current debate about the interconnection between chronic pain and society is economically narrowed. This involves the threat of losing sight of the fact that the interconnection between society and chronic pain is a complex entanglement that goes beyond economic costs. This article addresses the mentioned entanglement by acknowledging the following four levels of society: (1) the social structure, (2) the way of life, with special reference to occupation and its counterpart, leisure time, (3) the (normative) interpretation patterns of chronic pain and (4) the treatment situation. The applied sociological perspective shows that society, and this also includes medicine, is more than a mere addressee of problems. Society has to be considered as an influencing factor with respect to the development and stabilization of chronic pain. The outlined broadening of the perspective should contribute to a better understanding of the societal impact on chronic pain in order to stimulate an improvement in care and possibly a long-term reduction in costs.
- Published
- 2019
14. Versorgung chronischer Schmerzen
- Author
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Marcus Schiltenwolf, Kristin Kieselbach, and Claudia Bozzaro
- Subjects
medicine.medical_specialty ,Sports medicine ,business.industry ,Pain medicine ,Chronic pain ,Psychosomatic medicine ,medicine.disease ,Comprehension ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Nursing ,030202 anesthesiology ,Health care ,medicine ,Neurology (clinical) ,Justice (ethics) ,business ,Psychosocial ,030217 neurology & neurosurgery - Abstract
From the point of view of healthcare policies, improvement in pain care has been required for years; however, there is a great discrepancy between the current need for pain care and the actual provision by healthcare services. This article seeks to demonstrate that while healthcare policies are one of the critical factors involved, a variety of conceptual, diagnostic and therapeutic causes should also be taken into account. Firstly, considering that pain care is primarily concerned with the suffering of pain by patients, the focus lies with their conscious experience in order to define the patients' understanding of pain. Additionally, in this article current biomedical and psychosocial comprehension concerning chronic pain will be illustrated and why it is necessary to broaden our horizons in order to do justice to patients with chronic pain.
- Published
- 2016
- Full Text
- View/download PDF
15. [Pain Therapy Aspects in Tumour Surgery]
- Author
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Stefan, Wirz, Michael, Schenk, and Kristin, Kieselbach
- Subjects
Pain, Postoperative ,Treatment Outcome ,Neoplasms ,Hypertension ,Humans ,Pain Management ,Pain Measurement - Abstract
Due to preexisting pain or surgically induced sensitization patients undergoing oncological surgery are predisposed for a postoperative high pain intensity with the risk of developing persistent pain. In oncological surgery, pain therapy should be adapted to the underlying pain mechanism. Different treatment principles should be applied in a graded concept of acute pain therapy. The rationale implies the "conventional" use of the WHO step scheme, the administration of opioids as PCA as well as regional analgesia and agents with anti-hypersensitizing properties. Anti-hypersensitizing and anti-neuropathic treatment principles may include the use of antidepressants, anticonvulsants, intravenous lidocaine and s-ketamine. Before using such treatment, pain mechanisms should be verified by an adequate pain diagnostic. The impact of perioperative regional analgesia on the oncological outcome is subject to controversy. Opioids reveal both: tumor promoting and tumor inhibiting properties.Trotz einer Vielzahl von Therapieoptionen wird die Akutschmerztherapie nach onkologischen Operationen häufig als unzureichend beschrieben. Neben einer unzureichenden Akutschmerztherapie können weitere Faktoren eine Hypersensitivierung und Chronifizierung sowie den Verlauf der Tumorerkrankung beeinflussen. Dieser Beitrag erklärt pathophysiologische Hintergründe und erläutert geeignete Therapiemodalitäten.
- Published
- 2018
16. Schmerz aus anderen Perspektiven
- Author
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Claudia Bozzaro, Kristin Kieselbach, and Marcus Schiltenwolf
- Subjects
medicine.medical_specialty ,Neurology ,Sports medicine ,business.industry ,Pain medicine ,010102 general mathematics ,Psychosomatic medicine ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Family medicine ,medicine ,030212 general & internal medicine ,Neurology (clinical) ,0101 mathematics ,business - Published
- 2016
- Full Text
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17. Diffusion tensor magnetic resonance imaging (DTI) tractography-guided deep brain stimulation in neuropathic pain
- Author
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Volker A. Coenen, Irina Mader, Kristin Kieselbach, and Peter C. Reinacher
- Subjects
Pathology ,medicine.medical_specialty ,Deep brain stimulation ,medicine.medical_treatment ,Deep Brain Stimulation ,Clinical Neurology ,Context (language use) ,Trigeminal neuralgia ,medicine ,Humans ,Neuronavigation ,medicine.diagnostic_test ,business.industry ,Medial lemniscus ,Chronic pain ,Magnetic resonance imaging ,Trigeminal Neuralgia ,medicine.disease ,Diffusion Magnetic Resonance Imaging ,nervous system ,Neuropathic pain ,Surgery ,Neurology (clinical) ,Nuclear medicine ,business ,Tractography ,Letter to the editor - Functional - Abstract
Dear Editor, Chronic pain syndromes pose a challenge for interdisciplinary teams of pain specialists. We report a patient who presented with a neuropathic trigeminal pain syndrome after repeated resection of an epidermoid tumour involving the trigeminal ganglion. Multiple therapeutic approaches—including chronic motor cortex stimulation, intrathecal drug application and deep brain stimulation (DBS) to the periventricular/periaqueductal grey and sensory thalamus—did not lead to a sustained relief of pain with a persistent rating of 7-9 on the visual analogue scale (VAS). A magnetic resonance imaging (MRI) scan was suspicious for a malposition of the previously implanted clinically non-functional DBS electrodes. The DBS system was completely removed surgically. The patient underwent diffusion tensor magnetic resonance imaging (DTI). Imaging was performed on a clinical 3-T MRI system (Magnetom Trio Tim System 3 T; Siemens, Erlangen, Germany). DTI: single-shot, two-dimensional, SE EPI; TR, 10,000 ms; TE, 94 ms; diffusion values, b = 0 s/mm2 and b = 1,000 s/mm2; diffusion directions, 61; slice count, 69; voxel size, 2.0 × 2.0 × 2.0 mm3; acquisition time, 11:40 min. Deformation correction of the EPI sequence according to Zaitsev et al. [1]. DTI tractography: StealthViz-DTI system (Medtronic Navigation, Louisville, USA); FA level, 0.2; minimal fibre length, 10 mm; seed density, 5.0; maximal fibre cut-off angle, 50°. Tractography as shown here used the MCP coordinates of the previous (removed) and newly implanted electrodes. Three-dimensional visualisation and rendering of tracked fibres were performed with Amira (Konrad Zuse Zemtrum, Berlin, Germany and Visualization Sciences Group, SAS Bordeaux, France); electric stimulation as previously described [2]. At the day after imaging, two DBS electrodes were implanted stereotactically, assisted with the DTI technology (MCP coordinates cross-checked with DTI fibre-tracking results: VCP: laterality 11 mm, 2-mm anterior to PC, verticality at level of ACPC plane; PVG/PAG: 5-mm laterality, 2-mm anterior PC, verticality at level of ACPC plane). DTI tractography analysis revealed that the previously misplaced DBS electrodes were touching the median polysynaptic pain system (MPNS) (Fig. 1a-c, blue arrows). The newly placed electrodes (as displayed with helical computed tomography) now in addition reached the medial and trigeminal lemniscal systems (Fig. 1d, e). The patient’s VAS dropped almost instantaneously and remained stable with fluctuating levels between 2 and 5 over a period of 15 months. Fig. 1 a–c Deep brain stimulation (DBS) electrode positions (postoperative computed tomography superimposed onto preoperative T2-weighted MRI scans): a axial view at the level of the inter-commissural plane; b coronal view; c parasagittal view. Blue ... Recently, DBS of the medial lemniscus in neuropathic pain after planning with tractography has been described [3]. This line of investigation is likely to be fruitful in the light of successful stimulation of fibre tracts in other indications [2, 4–6]. The PAG/MPNS system is concerned with autonomic, emotional and pain function. In the context of DBS, the connectivity of the PAG has been previously addressed utilising the DTI technology [7, 8]. In accordance with our own tractography studies [9], we are convinced that one previously described upstream projection [8] is confluent with the ATR system that at different levels (midbrain, PAG, prefrontal cortex, bed-nucleus of the stria terminalis) connects with the MFB system. Recently we have shown in a pilot study that direct stimulation of the MFB has strong anti-depressive effects [6]. Since PAG/PVG stimulation is located in a supposed connection hub of MFB/ATR, it is possible that PAG stimulation alters the network balance of the ATR system in favour of the MFB system and diminishes emotional and somatic pain. We have elaborated on the limitations of the DTI technology in our previous publications [2, 4, 5]. This report strengthens the idea of the application of the DTI tractography technology for DBS surgery in neuropathic and nociceptive pain and, moreover, for the thorough analysis of the electrode positions obtained with respect to the fibre systems, which in addition to computation of somatic pain are concerned with emotion processing.
- Published
- 2014
18. The impact of psychological factors on outcomes for spinal cord stimulation: an analysis with long-term follow-up
- Author
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Tilman, Wolter, Ingrid, Fauler, and Kristin, Kieselbach
- Subjects
Adult ,Male ,Psychiatric Status Rating Scales ,Depressive Disorder ,Spinal Cord Stimulation ,Anti-Inflammatory Agents, Non-Steroidal ,Pain Perception ,Anxiety ,Middle Aged ,Self Efficacy ,Statistics, Nonparametric ,Surveys and Questionnaires ,Humans ,Neuralgia ,Disabled Persons ,Female ,Longitudinal Studies ,Aged ,Pain Measurement ,Retrospective Studies - Abstract
For more than 3 decades, spinal cord stimulation (SCS) has successfully been employed to treat neuropathic pain. Psychological factors are assumed to be important for the efficacy of SCS. However, the impact of psychological factors on the outcome of SCS has only rarely been studied.The aim of this study was to determine the influence of psychological factors such as anxiety and depression, perceived disability, and self efficacy on the outcome of SCS in a representative clinical sample.Retrospective study.Academic university interdisciplinary pain center.We reviewed the records of 60 consecutive patients who had been treated at our institution with lumbar, thoracic, or cervical neurostimulators between July 1, 2008, and June 30, 2012. Information with respect to age, gender, diagnosis, age at time of implantation, disease duration, the preoperative Hospital Anxiety and Depression Test, German Version (HADS-D), the Pain Disability Index (PDI) and preoperative pain scores on an 11 point Numeric Rating Scale (NRS) were recorded. In addition, a questionnaire was mailed to participants that contained the following items: pain scores on the NRS with and without stimulation, time intervals of stimulation, paresthesia coverage, treatment satisfaction and medication intake, anxiety/depression (HADS-D and Beck Depression Index II [BDI-II]), PDI, and self efficacy using the Fragebogen zur Erfassung der schmerzspezifischen Selbstwirksamkeit (FESS).Preoperative HADS-D, PDI, and NRS pain scores were not different in those patients with an unsuccessful trial and those who underwent IPG implantation. Long-term outcomes were not affected by pre-implantation HADS-D or PDI scores. FESS scores showed a strong inverse correlation with HADS-D, BDI-II, and PDI scores and showed a tendency towards correlation with the percentage of pain reduction. HADS-D and PDI scores improved after SCS therapy.Retrospective study.The outcome of SCS therapy could not be predicted on the basis of tested psychological factors anxiety/depression and pain-related disability. FESS correlated inversely with HADS-D, BDI-II, and PDI scores and showed a tendency towards correlation with the percentage of pain reduction. Further research is needed to define the impact of psychological factors on SCS outcomes.
- Published
- 2013
19. Cervical spinal cord stimulation: an analysis of 23 patients with long-term follow-up
- Author
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Tilman Wolter and Kristin Kieselbach
- Subjects
Adult ,Male ,Time Factors ,medicine.medical_treatment ,Upper limb pain ,Stimulation ,Electric Stimulation Therapy ,Medicine ,Humans ,Paresthesia ,Neurostimulation ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Middle Aged ,Trunk ,Lower limb pain ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Spinal Cord ,Anesthesia ,Neuropathic pain ,Cervical Vertebrae ,Neuralgia ,Female ,Implant ,business ,Follow-Up Studies - Abstract
Background: For more than 3 decades, spinal cord stimulation has successfully been employed to treat neuropathic pain. Cervical spinal cord stimulation, despite now being standard in many hospitals, has only rarely been subjected to a critical review within the literature. Objectives: The aim of this study was to determine the efficacy of cervical spinal cord stimulation (SCS) in a representative clinical sample. We also wanted to evaluate how factors such as stimulation parameters, unwanted paresthesia of the trunk and legs, and changes in paresthesia status due to head movement and how they affect SCS effectiveness. Study design: Retrospective study. Setting: Academic university interdisciplinary pain center. Methods: We reviewed the records of patients who had been treated at our institution with cervical neurostimulators from November 1, 2001 through October 31, 2011. Information regarding age, gender, diagnosis, age at time of implantation, duration of disease, lead position, hardware in use, revision operations, and stimulation parameters were recorded. In addition, a short telephone interview was conducted, which contained the following items: pain scores on the numeric analog scale (NAS) with and without stimulation, time intervals of stimulation, paresthesia coverage, changes in paresthesia coverage by head movements, unwanted paresthesia of the trunk and legs, treatment satisfaction, and medication intake. Results: Twenty-three patients were treated. Eighteen patients proceeded to an implantable pulse generator (IPG) implant. In one patient, the system was removed after 4 years despite optimal function, because the patient was no longer experiencing pain. Average NAS pain scores were 6.8 (range 5.5 - 10.0, standard deviation [SD] 1.7) without, and 2.8 (range 0 - 7.5, SD 2.2) with neurostimulation. Fourteen revisions (5 due to lead dislocation, 5 due to lead breakage and 4 IPG revisions) were necessary in 9 of the 18 patients during a mean follow-up of 6.2 years. Most patients reported complete paresthesia coverage. Four patients reported unwanted paresthesia of the trunk or lower limb and 11 patients reported changes in paresthesia with head movements. In both instances, pain reduction was not affected. Limitations: Retrospective study. Conclusions: Cervical spinal cord stimulation appears to be effective in the treatment of neuropathic upper limb pain. Complications are not significantly more frequent than in SCS for lower limb pain. Changes in paresthesia with head movements and unwanted paresthesia did not affect the outcome. Key words: Spinal cord stimulation, cervical, neuropathic pain, clinical efficacy, paresthesia, paresthesia coverage, changes in paresthesia, brachial plexus lesion, nerve root avulsion, stimulation parameters
- Published
- 2012
20. Spinal cord stimulation for Raynaud's syndrome: long-term alleviation of bilateral pain with a single cervical lead
- Author
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Kristin Kieselbach and Tilman Wolter
- Subjects
medicine.medical_specialty ,Pain relief ,Stimulation ,Electric Stimulation Therapy ,Spinal cord stimulation ,medicine ,Humans ,Lead (electronics) ,Pain Measurement ,S syndrome ,integumentary system ,business.industry ,Chronic pain ,Raynaud Disease ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Electrodes, Implanted ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Treatment Outcome ,Neurology ,Spinal Cord ,Single lead ,Thermography ,Anesthesia ,Cervical Vertebrae ,Female ,Neurology (clinical) ,Chronic Pain ,business ,Cervical vertebrae - Abstract
Introduction: Spinal cord stimulation (SCS) has been described in a variety of neuropathic and vasospastic pain conditions including Raynaud's syndrome. Methods: We report here the outcome of single lead SCS in the case of a 49-year-old woman with severe Raynaud's syndrome, which had failed to respond to medical therapy. Results: With a single quadripolar cervical lead in midline position at the C2/C3 level sustained pain relief of the bilateral pain was accomplished. Pain scores sank from 7/10 to 2–3/10 on the nominal analog scale and remained stable more than nearly four years by now. Conclusions: Treatment of bilateral pain in Raynaud's syndrome with SCS in a single technique is feasible. Advantages and disadvantages as compared with stimulation with bilateral leads are discussed.
- Published
- 2011
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