Pain is one of the most expensive challenges for the healthcare system and is a heavy burden for affected patients and their relatives. At the 6th Aachen workshop, to which Grünenthal invited at the beginning of December 2010, the focus was on the topic “Future of Pain Therapy”. Experts from various disciplines shed light on the care situation for patients with severe pain in Germany. Conclusion: The therapeutic care of chronic pain patients is still characterized by undersupply. That's why a demand from the health economist Prof. Dr. med. Dipl-Kfm. Rainer Riedel: “In order to improve the care situation for patients, we first have to raise money.”

> Right at the beginning of his lecture on the current situation of pain patient care in Germany from a health economics perspective, Prof. Dr. Rainer Riedel, Rheinische Fachhochschule Cologne and Director of the Institute for Medical Economics & Medical Care, points out where one of the main problems lies: “We don’t have any good, reliable data.” In addition, so-called end-haul patients have so far mainly been considered. “Pain patients first come to their family doctor,” explained Riedel. The key question at this point should therefore be: What point in time is defined at which the patient must go from the family doctor to a specialist in order to avoid chronic pain. In addition, it is essential to define handover criteria so that the pain patient is introduced to professional care at an early stage. According to Rainer Riedel, the big challenge in improving the current care structure and service is to avoid chronic pain. “We therefore have to start relatively early in the treatment process, otherwise we have little chance of success.”
Riedel showed how urgently needed it really is to improve the situation for pain patients using some figures “that should wake us up”. In Germany, one in three adults suffers from chronic pain. This corresponds to around 17 percent of the total population. According to data from the Federal Institute for Occupational Safety and Health, back pain alone leads to 112 million days of incapacity for work (AU). “The resulting production losses are calculated at 10.6 billion euros,” said Riedel.
If intervention is made early in the treatment process, costs can ultimately be reduced. “But we first have to invest money for this,” explained Riedel, “because the improvement doesn’t come for free.”
Using the example of the heart failure program “CorBene,” which has already been successfully implemented, Riedel made it clear that an optimized treatment regimen could improve therapy and ultimately reduce costs. What was important was the precise coordination and definition of the acceptance criteria between the family doctor and specialist. According to Riedel, this model could also be transferred to the area of pain. The relevant criteria would have to be determined by the specialist societies and pain therapists. “In the end, we have to have developed a standard operating procedure (SOP) that everyone adheres to.” What is crucial for success is “that the patients are initially clustered correctly. The inclusion and exclusion procedures for certain groups must be correct, otherwise the therapy will not work,” Riedel pointed out. His conclusion at the end of the lecture: “We can only move forward if we are prepared to change the supply path.”
Professor Dr. gave a medical insight into the status quo of pain patient care in Germany. Dr. Thomas Tölle from the Neuro-Head Center at the Rechts der Isar Clinic. As a member of the commission for research questions in the German Society for the Study of Pain (DGSS), Tölle stated: “The patient should know early on that the basic concept is a biopsychosocial treatment.” The aim is: pain reduction, preservation of function, social integration and independence . In order to take into account the complexity and multifaceted nature of a pain disorder, optimal pain therapy currently requires the integration of various specialist disciplines into an interdisciplinary team. According to the pain expert, from the point of view of caring for pain patients, “collaboration and information is required at all levels of pain care”. These included private practices, specialized pain centers, pain organizations and political committees. “Our goal,” says Tölle, “must be to prevent the development of chronic pain through early intervention or to effectively address already chronic pain through a differentiated combination of different treatment strategies.” This is the only way to really improve the quality of life of pain patients.
In one of the six workshops, Sveja Eberhard, policy and health services research department at AOK Lower Saxony, presented a care model that has already been implemented together with Integrated Managed Care GmbH and a doctor's practice in Hanover as contractual partners. The aim of this model was to shorten the AU times, avoid operations as well as early retirement and optimize the supply of medicines and therapeutic products. 280 potential participants were expected for the pilot region. After extensive screening and “despite constructive intersectoral collaboration, the number of possible participants was only 92.” In Eberhard's opinion, the main reason for the low participation rate was the fact that “it was very difficult to motivate patients to take part in the entire program.” Nevertheless, the program also showed that the cooperation between the sectors worked very well and that there was definitely potential to improve the care of pain patients,” concluded Sveja Eberhard. <<