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Poster-Abstract

Multimodal pain treatment programs are widely accepted as the medical treatment standard in the management of patients with chronic pain syndromes. The concepts and treatment strategies are based on the biopsychosocial model of pain and programs for early restoration of function. Although this concept is primarily implemented in the curative field, i.e. in hospitals for the treatment of patients with chronic pain diseases, modified programs based on the International Classification of Functioning (ICF) can now also be found in rehabilitation clinics. Despite the assumed similarities, significant differences in, for example the aims of the therapy and relevant structural and process variables have to be kept in mind when allocating patients to a program as provided by a hospital or a rehabilitation clinic. The aim of this article is to present the framework structures of both treatment levels with respect to the implementation of multimodal pain therapy programs and to elucidate the differential diagnostic approach to the indications.

Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management. In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.

According to evidence-based German national guidelines for non-specific low back pain, a broad multidisciplinary assessment is indicated after persisting pain experience of 6 weeks in order to check the indications for an multi- and interdisciplinary pain therapy program. In this paper the necessary topics, the content and the disciplines involved as well as the extent of the multidisciplinary assessment are described as developed by the ad hoc commission on multimodal pain therapy of the German Pain Society.

Malignant melanoma (MM) is a cancer with rapidly growing incidence in all age groups and-if not detected early-mostly poor prognosis. After wide excision of the primary tumour, patients without metastases are subjected to follow-up examinations. No further standard medical treatment is currently available for such patients. This results in psychosocial stress, and psychological adjustment and social support are needed-especially in patients with poor prognosis and visible scars. This article reviews recent evidence of the psychosocial correlates in melanoma disease in the context of past research. Factors discussed include psychosocial distress, coping with cancer, support from the social network, and the need for professional psychosocial intervention and its effectiveness. Previous studies which have investigated the correlation between psychosocial factors and the course of the disease are also reviewed. Additionally, suggestions for future research are discussed.

For a period of seven years medical students have had the opportunity to attend Balint-seminars in an intensive training course in the field of "Medical Psychology and Psychotherapy" during their clinical education. In groups of 10-15 students the participants study conscious and subconscious aspects in the relationship between students and patients in the setting of their practical work in hospital. Some of these students additionally hold supporting conversations with mentally and psychosomatically ill patients. This takes place at the Psychotherapeutic Department and at the Department of Psychiatry, both at Innsbruck University, and is supervised in the Balint-seminars. In addition to this psychoanalytically oriented supervision theoretic knowledge (socio-psycho-somatic aspects of illnesses, subconscious aspects in the doctor-patient-relationship, phenomena of transference and counter-transference) is being brought across. In the students' Balint-seminars both patient-related self-experience and the reflection upon the students' social role in hospital acquire special importance. The development of this model of teaching and learning and the experiences which have been achieved over the last seven years are described in this article concerning the practicability for a patient centered model in the education of medical students.