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Background: Up to the early 2000s the need for optimization in the treatment of acute pain in hospitals was highlighted. Only a few successes were achieved in the optimization process. As the acute pain care in Germany remained persistently unsatisfactory, the first health services research projects in pain medicine were initiated. These were intended to achieve improvements in patient care., Aim: To illustrate the beginnings of health services research in the field of pain medicine in Germany the research projects "Pain-free hospital" and "Action alliance pain-free City of Münster" as well as the certification initiative Certkom are described., Material and Methods: An analysis of the current state of pain care for patients and interdisciplinary pain management, the derivation of optimization measures, their implementation and subsequent evaluation were carried out in all the projects presented in the sense of a complex intervention., Results: All the projects could achieve improvements in patient care through a systematic survey of the current situation, targeted planning and the introduction of optimization measures. Corresponding evaluations could demonstrate these results., Conclusion: The systematic approach in the projects with the collation of scientific data in real-life care has achieved optimization in acute pain management. The foundations were laid for further healthcare research in pain treatment in Germany; however, the projects also revealed limitations in the inclusion of vulnerable patient groups., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: N. Nestler erhielt in den letzten 3 Jahren Honorare von B. Braun und Mundipharma international für Juryaktivitäten und Referate. Sie ist Schriftführerin der Deutschen Schmerzgesellschaft e. V., Mitglied der Ad-hoc-Kommission Curriculum Pflegefortbildung und Schmerz der Deutschen Schmerzgesellschaft e. V., Chair der Nursing Group der European Pain Federation (EFIC) und Chair der Health Literacy Campaign der European Pain Federation (EFIC). C. Maier erhielt in den letzten 3 Jahren Honorare von Pfizer (Berlin). J. Osterbrink gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

To evaluate the quality of care, particularly in the case of new forms of healthcare interventions, the healthcare services to be provided are defined and documented in advance. The presented explanatory sequential mixed methods design combines quantitative and qualitative data collection and the analysis enables a deeper understanding of a new healthcare intervention. Using the example of the POET-Pain project, which investigates the effect of a perioperative transitional pain service (TPS), the methodological application of the explanatory sequential mixed methods design is demonstrated in order to present the structural and process evaluation of the new healthcare intervention (in this case TPS) and to understand its influence on the quality of care. The mixed methods design presented enables the results of the quantitative phase to be interpreted and expanded in depth using qualitative data, which leads to a comprehensive understanding of the subject matter (second pillar of health services research)., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: I. Gnass, S. Berger, N. Schürholz, U. Kaiser, A. Schäfer und A. Schnabel geben an, dass kein Interessenkonflikt besteht. E. Pogatzki-Zahn erhielt in den letzten 3 Jahren Gelder von Grünenthal für wissenschaftliche Projekte und von Grünenthal, Novartis und Medtronic für Vorträge und Advisory-Board-Aktivitäten. Sie erhält momentan bzw. erhielt in den letzten 3 Jahren wissenschaftliche Gelder für Forschungsprojekte von der Deutschen Forschungsgemeinschaft (DFG), dem Bundesministerium für Bildung und Forschung (BMBF), dem Gemeinsamen Bundesausschuss (G-BA) und dem European Union’s Horizon 2020 research and innovation programme. Alle diese Gelder gingen an die Einrichtungen, für die E. Pogatzki-Zahn arbeitet, nicht an sie persönlich. E. Pogatzki-Zahn ist „council member“ der International Association for the Study of Pain (IASP), Schatzmeister der Deutschen Schmerzgesellschaft e. V., Past Chair und Treasurer der Acute Pain Special Interest Group (SIG) der IASP, „research committee member“ der European Society of Anaesthesiology and Intensive Care (ESAIC), Chair der „research group“ der European Pain Federation (EFIC), Mitglied der ESRA-PROSPECT Group, Debuty Editor in Chief für das European Journal of Anaesthesiology (EJA) und das European Journal of Anaesthesiology and Intensive Care (EJAIC) und Section Editor für das European Journal of Pain (EJP). N. Nestler erhielt in den letzten 3 Jahren Honorare von B. Braun, Mundipharma international für Juryaktivitäten und Referate. Sie ist Schriftführerin der Deutschen Schmerzgesellschaft e. V., Mitglied der Ad-hoc-Kommission Pflegecurriculum Schmerz der Deutschen Schmerzgesellschaft e. V, Chair der „nursing group“ der European Pain Federation (EFIC) und Chair der Health Literacy Campaign der European Pain Federation (EFIC). Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

Many studies still indicate insufficient pain management after surgery, e.g., in patients after small- or medium-size operations. Yet it is still uncertain if postoperative pain based on patient-related outcomes can be improved by implementing guideline-related programmes in a multicentre approach. Adult patients in six hospitals in one German city were included in this prospective study. Data collection took place twice in each hospital, once before and once after implementation of concepts and in-house training. Pain and pain-related aspects were assessed one day after surgery and compared between the pre- and post-test group including subgroup analysis of certain surgical procedures by using Student's t-tests, Mann-Whitney U tests and chi-square tests (alphatwo-tailed = 0.05). Overall, pain at rest and during movement was slightly lower after the intervention. Significant changes were observed after thoracic surgery, small joint surgery and other minor surgical procedures. The rather moderate decrease in pain likely relates to a reasonable pre-existing pain management and to detached improvements in certain patient subgroups. Interestingly, specific analyses revealed significantly lower post-test pain as compared to pre-test pain only in patients without pre-existing chronic pain. Side effects related to pain medication were significantly lower after intervention. Our data show, for the first time, benefits of a perioperative teaching programme in a multicentre approach. Pain ratings improved mainly in specific subgroups of patients, e.g., small surgical procedures and patients without preoperative pain. Thus, general improvement is possible but special attention should be paid to the group of patients with preoperative pain.

Background: The Department of Neurology at the Medical University Graz has implemented a multiprofessional pain management concept and evaluated the outcome by means of a patient survey., Methods: Standard operating procedures for standardised pain measurement, documentation and therapy were developed. All engaged professional participants were trained before implementation., Results: 88.7 % of the surveyed 63 patients reported pain during the hospitalisation. During the night and in the morning, the occurrence of severe pain was most likely. The position or activity most likely triggering severe pain was mobilisation (19 %). Patients with degenerative diseases of the spine without radiculopathy reported the highest levels of pain., Conclusions: Pain is an important problem for neurological inpatients. Nocturnal pain, pain induced by mobilisation, and pain therapy for patients with degenerative diseases of the spine without radiculopathy require particular attention., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The aim of this study was to analyze the degree of organization of different standard protocols for acute pain management, as well as the derivation and definition of typical but structurally different models., Methods: A total of 85 hospitals provided their written standardized protocols for analysis. Protocols for defined target processes from 76 hospitals and another protocol used by more than one hospital were included into the analysis. The suggested courses of action were theoretically simulated to identify and characterize process types in a multistage evaluation process., Results: The analysis included 148 standards. Four differentiated process types were defined ("standardized order", "analgesic ladder", "algorithm", "therapy path"), each with an increasing level of organization. These four types had the following distribution: 27 % (n = 40) "standardized order", 47 % (n = 70) "analgesic ladder", 22 % (n = 33) "algorithm", 4 % (n = 5) "therapy path". Models with a higher degree of organization included more control elements, such as action and intervention triggers or safety and supervisory elements, and were also associated with a formally better access to medication. For models with a lower degree of organization, immediate courses of action were more dependent on individual decisions. Although not quantifiable, this was particularly evident when simulating downstream courses of action. Interfaces between areas of hospital activity and a cross-departmental-boundary validity were only considered in a fraction of the protocols. Concepts from clinics with a certificate in (acute) pain management were more strongly process-oriented. For children, there were proportionately more simple concepts with a lower degree of organization and less controlling elements., Conclusion: This is the first analysis of a large sample of standardized protocols for acute pain management focusing on the degree of organization and the possible influence on courses of action. The analysis shows how different the structures and presumably the practical objectives of the various concepts are. The analyzed protocols with a lower degree of organization can manage only the assignment of a particular medication to the corresponding patient group, with a presumably high requirement for considerable implicit knowledge of the responsible employees. Accordingly, a requirement for such protocols should be that they not only describe the preferred standard therapy, but also define the interactions between the staff members involved. It remains questionable whether a protocol with a low level of organization and a comparably high requirement for implicit knowledge and individual action--also from nonmedical personnel--is able to ensure efficient pain therapy, particularly in view changing staff and dynamic responses to changing pain situations.

Background: Research on the quality of pain management is often based on self-reported data pertaining to internal regulations provided by employees. However, data examining the correctness of the information given are rare. The project "Pain-Free Hospital" facilitated such an analysis and compared the answers provided by staff members with currently existing regulations., Methods: In the course of the project (2004-2006) data on internal pain-related therapy plans, pain management-related regulations as well as the level of knowledge of 3421 nurses, 1757 physicians (825 conservative ward physicians, 728 surgeons and 526 anesthesiologists) from a total of 19 hospitals were collected and examined prior to and after the implementation of a specific training intervention. The congruence of the answers given was measured., Results: After training 16 surgical wards (previously 12) and 13 conservative wards (previously 2) had standardized therapy plans. Regulations existed in 13 conservative (previously 12) and 16 surgical wards (previously 12). In those hospitals with standardized therapy plans, a significantly higher level of knowledge was found among staff members after the intervention (p < 0.05), especially on surgical wards. In hospitals without therapy plans and regulations there were significantly more incongruent answers (p < 0.05). In comparison to colleagues from conservative wards, surgical nurses and physicians provided significantly more incongruent answers., Conclusion: Therapy plans and pain management-related regulations are known in hospitals after a systematic training. Data suggest that hospitals without regulations show a trend towards social desirability.

A research project addressing roles of nurses in pain management is described. The role of specialized pain management nurses is discussed. Standards, communication, and multidisciplinary care, as well as roles of nurses in hospitals, nursing homes, and home care are described. Specialization is discussed including training and certification. The German National Expert Standard for Pain Management in Nursing is described.

Background: High healthcare needs are evident for pain caused by cancer. Those affected are not only looking for help in acute inpatient structures but also for a much larger part in outpatient care structures. To avoid mistreatment, undertreatment or overtreatment of pain in people with cancer, it is necessary to differentiate the tasks and roles of different providers while highlighting the specific aspects of pain management within the given network structures., Materials and Methods: Aspects, such as pain assessment and the necessary scope of action in pain treatment are illustrated from the perspective of nurses from home care services, primary physicians as well as the general or special ambulatory palliative care (AAPV or SAPV) on the basis of initial survey results and a documentation analysis., Results: Ambulatory care nurses (93 %) and primary caregivers (64 %) use pain assessment scales. The kind of scales used varies. The ability to provide adequate pain care for patients in the immediate care situation is reported as given by more than half of the nurses (56.6 %)., Conclusions: In order to ensure an adequate pain therapy targeted interprofessional coordination is required between outpatient and primary physicians with respect to aspects of pain assessment, scope of action and accessibility.

Background: The application of non-pharmacologic therapy (NPT) within pain therapy increases patient satisfaction and is, in addition to pharmacologic methods, recommended in the National Expert Standard on Pain Management in Nursing of the German Network of Quality Development in Nursing. If and to what extent non-pharmacologic methods are applied within pain therapy in German hospitals has as yet been unknown., Materials and Methods: Within the project "Pain-Free Hospital" 2,840 nurses in 25 hospitals were interviewed via questionnaire forms and oral interviews about the use of NPT., Results: Of the nurses 80% confirmed the use of NPT. The majority of the interviewed nurses applied superficial cold, bedding and heat for pain relief. We identified barriers to the implementation of NPT, such as the scarce knowledge of nurses about these therapeutic areas and the uncertainty whether NPT needs to be described by doctors or not., Conclusion: Some of the NPTs are well established in hospitals. For nationwide use of NPT their systematic training and implementation is necessary.

Inadequate pain care in health care facilities is still a major concern. Due to structural and organizational shortcomings the potential of modern analgesia is far from being exhausted. The project "Action Alliance Pain-free City Münster" is designed to analyze the multiprofessional pain management in health care facilities in the model City of Münster in an epidemiologic study and aims to optimize pain management in accordance with nursing standards and medical guidelines. Hospitals, nursing homes, outpatient nursing services, hospices and pain care centers will be examined. After an analysis of the current state on the basis of a pre-test, the necessary optimization measures will be developed and implemented. Subsequently, the pain management will be reevaluated in a post-test. In partly still unexplored health care areas of Germany, epidemiologic data will be generated, barriers to the implementation of standards and guidelines revealed and measures of improvements developed and tested. In addition, interface problems between the evaluated sectors will be identified. In this article the objective and the methods of the project are described.

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Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)