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The mean pain intensity for inpatient consultations, for example in cancer patients, is known. However, the proportion of necessary consultations in the total volume of patients of a ward or a hospital, the general pain intensity in a surgical ward and the relationship between pain medication, length of stay and therapeutic success are unknown. The aim of the study was to examine surgical patients in a single normal ward subclassified into various groups (−/+ surgery, ICU stay, cancer, consultation for pain therapy etc.) during half a year with regard to their pain. For this purpose, the pain score (NAS) was recorded daily for each patient during the entire hospital stay and the change was assessed over the clinical course.

Palliative care is dedicated to terminally ill patients with advanced disease, regardless of diagnosis, under the overarching premise of optimizing quality of life. This narrative review examines the extent to which principles of cybernetics and psychophysiology underlie this approach. Psychophysiology researches the physiological equivalents of psychological states and traits such as activation and individual reactivity, the interoception and the personal characteristics. Cybernetics specifies these principles, which are possible by understanding terms such as "psychophysiology" or "cybernetics" or "self-organization/autopoiesis". The meaning of these terms for palliative care can also be elucidated in relation to the terms "biofeedback", "consciousness", "pain", and "anxiety". The common themes of cybernetics and psychophysiology are environment, subjectivity, personality characteristics, the difference between time scale separation in cybernetic systems, and real-time procedures in environment and rhythm. These lead to special therapies based on psychophysiology, such as consciousness training. The concepts of quality of life, causality, the biopsychosocial model, therapy, and autonomy are examined as palliative care concepts. The equivalents can be described from the perspective of cybernetics. For some palliative care-related terms, cybernetic thinking is already present (quality of life, autonomy, symptom control), while for others, it is not (biopsychosocial). Cybernetic terms (complexity, stability, identity, rhythm) are still used to a lesser extent in palliative care. Terms like genetic basis are common in cybernetics and psychophysiology to explain the identity of the subject in transition. Identity, on the other hand, is the basis of the concept of dignity in palliative care. Psychophysiology investigates disturbances like pain and psychological illnesses, which are also present in palliative care. Psychophysiology, cybernetics, and palliative care have subjectivity and resources in common. Therapies based on cybernetic principles of psychophysiology can also be used for symptom control in palliative care in the oncology setting. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to define the different levels of psychological distress in patients suffering from pain and functional disorders of the musculoskeletal system. Methods: This investigation was conducted as a retrospective study of 60 patients randomly selected of a German specialized orthopaedic hospital within the year 2016, whose therapeutic approaches are based on a non-surgical orthopaedic multimodal approach of manual therapy. All patients were suffering from pain and functional disorders of the musculoskeletal system. Two groups were formed: one without and one with additional mental disorders according to ICD-10. The impairment score (ISS) according to Schepank was determined. Results: The somatic sub score of the ISS was the highest sub score in both patient groups. The cumulative value of the ISS score of patients with both a mental disorder and pain in the musculoskeletal system was higher than for patients without concomitant mental disorder. For patients without concomitant mental disorder, the cumulative ISS exceeded the test criteria for mentally healthy individuals. Conclusions: Patients without mental disorder but with chronic pain of the locomotoric system receive a psychological pain management program, as it is part of the billing code OPS 8-977 to the health insurance companies in Germany. However, the data show that these patients also have a substantial somatic subscore and a cumulative ISS above the level of healthy individuals. The absence of psychological disorders (according to ICD-10) in patients with pain of the musculoskeletal system should not lead to the assumption that these patients are psychologically inconspicuous. Subsyndromal mental findings (below ICD-10) can be one aspect of a mental disorder presenting with primarily somatic symptoms. In this case, patients would benefit from a psychotherapeutic program in a similar way as the patients with mental disorders according to ICD-10. [ABSTRACT FROM AUTHOR]

Objectives: Evidence suggests that patients with chronic pain and mental illness are more likely to receive long-term opioid therapy (LTOT) and at higher doses but are also at increased risk of experiencing opioid-related harm. This study investigates LTOT and its relationship to mental illness in the setting of a university-based outpatient pain clinic with liaison psychiatric care., Methods: Retrospective analysis of patients with chronic pain admitted between 2011 and 2015. After a 1-year treatment period, patients with non-opioid treatment, guideline-recommended LTOT, and high-dose LTOT were compared, and multiple regression analysis was performed to identify predictors of higher opioid dosage., Results: Of 769 patients, 46% received LTOT (opioids for >90 consecutive days), 13% at high dosage (>120 oral morphine milligram equivalents [MME] / day). Two thirds of all patients had mental illness. The prevalence of psychiatric diagnoses and prescription rate of psychotropic medication did not significantly differ between groups. Pain chronicity stages, use of antidepressants, and sex significantly predicted MME/day but explained only a minor part of the variance. The association with antidepressants can be attributed to the prescription of antidepressants for analgesic purposes rather than for treating depression. No association with any other type of psychiatric disorders was observed., Conclusion: This study shows that mental health comorbidity is highly prevalent but that the prescribed opioid dosage is independent of it in the clinical setting of this study. The concept of liaison psychiatric care might have essentially contributed to the "detachment" of opioid prescription and psychiatric conditions but cannot be isolated from other potentially contributing factors within this single-center observational study., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

As a result of the demographic change, the proportions of elderly patients undergoing operations and anesthesia are increasingly important. The consumption of benzodiazepines evidently rises with increasing age. Associated with the increasing consumption in the elderly is the risk of cognitive impairment, delirium, falls and fractures. Also long-term benzodiazepine use in low-dose may induce perioperative withdrawal syndrome. The following article will present characteristics and complications accompanied by critical benzodiazepine use especially in the elderly patients., (© Georg Thieme Verlag Stuttgart · New York.)