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There is currently a lack of studies that evaluate the effects of matrix electrode neuromodulation on acute pain. In this prospective and randomized cross-over study, we investigated the efficacy of 4 Hz-matrix stimulation on venipuncture-induced pain in 30 healthy subjects.We compared two conditions of neurostimulation: in EC1 (experimental condition 1), we performed venipuncture during stimulation, with 2.5 min of prestimulation with 600 stimuli; in EC2 (experimental condition 2), the length of stimulation was 5 min, at 1200 stimuli, with subsequent venipuncture. A group with no stimulation was used as control condition.The EC2 group did not only show a 77% reduction in puncture pain when compared to the control group (p 0.001; effect size [ES] d = 1.45), but also had a significant effect compared with EC1 (p 0.001; ES d = 1.33). EC1, on the other hand, did not demonstrate a significant difference to the control group. The status of the veins was evaluated based on visibility and did not differ significantly between the conditions.The results of this study showed for the first time that pre-emptive matrix stimulation could be an effective way to reduce acute pain. The duration of stimulation seems to play a key role in the effectiveness of the neurophysiological mechanism of action. Matrix stimulation is a therapeutic intervention with very few side effects, which could, in the future, expand our pain-management options for the treatment of acute pain.

Hintergrund und Fragestellung: Die Deutsche Krebshilfe hat den Ausbau der fur eine flachendeckende ambulante Palliativversorgung notwendigen qualitatsgesicherten Versorgungsstrukturen mit einem Schwerpunktprogramm gefordert. Die geforderten 12 Pilotprojekte, die mit verschiedenen Modellen bei unterschiedlichen Rahmenbedingungen die ambulante Palliativversorgung verbessern wollten, wurden von einer einheitlichen Evaluation begleitet. Patienten und Methodik: Die geforderten Projekte dokumentierten bei individuellem Projektstart und Projektende alle behandelten Patienten mit dem Basisbogen der Hospiz- und Palliativ-Erhebung (HOPE) und dem Minimalen Dokumentationssystem fur Palliativpatienten (MIDOS). Insgesamt konnten die Daten von 3239 Patienten deskriptiv ausgewertet werden. Zusatzlich zu den quantitativen Daten wurden die Erfahrungen aus den Projekten in mehreren Workshops erfasst (2008, 2009, 2010, 2012). Insbesondere die im Rahmen des Abschlusstreffens im Juli 2012 berichteten Erfahrungen und die Abschlussberichte an die Deutsche Krebshilfe wurden fur diese Auswertung berucksichtigt. Ergebnisse: In der quantitativen Auswertung hatten 85,6 % der 3239 palliativ versorgten Patienten eine Tumordiagnose. In allen Modellprojekten wurde das Ziel eines Netzwerks mit enger Zusammenarbeit von Primarversorgern, sozialer Unterstutzung und ambulanten und stationaren spezialisierten Diensten erreicht. Fur alle Projekte war die Anschubfinanzierung der Deutschen Krebshilfe extrem wichtig, da die Vertragsgestaltung mit den Krankenkassen in den Regionen langsam geschah und dann auf den Erfahrungen aus den Projekten aufbauen konnte. Schlussfolgerung: Den Teilnehmern des Projektleiter-Abschlusstreffens schien fur die Versorgungsplanung eine Marktanalyse notwendig – unter Berucksichtigung der unterschiedlichen regionalen und lokal gewachsenen Versorgungsstrukturen und der Zielgruppe der Patienten. Ausbildungs-, Fort- und Weiterbildungsangebote tragen wesentlich zur Vernetzung bei. Eine einrichtungsubergreifende und verlasslich finanzierte Koordinierungs-Stelle bzw. ein Case Management ist sehr wichtig.

Bei Patienten in palliativmedizinischer Betreuung kommen Schmerzen nicht nur im Rahmen von Tumorerkrankungen, sondern auch als Muskelschmerzen im Rahmen einer Spastik bei multipler Sklerose, amyotropher Lateralsklerose oder nach einem Hirninfarkt sowie einer Demenz mit jeweils begleitender Pyramidenbahnschadigung vor. Hilfreich sind hier zentral wirksame Muskelrelaxanzien, die auch als Koanalgetika beim Tumorschmerz eingesetzt werden konnen. Neben Opioiden sind andere Koanalgetika wie trizyklische Antidepressiva oder Serotonin-Noradrenalin-Wiederaufnahmehemmer ebenso wie Antikonvulsiva vom Typ der Kalziumkanalmodulatoren oder Natriumkanalblocker hilfreich, wenn ein Tumorschmerz mit neuropathischer Schmerzkomponente vorliegt. Das idiopathische Parkinson-Syndrom oder Multisystematrophien fuhren eher zu einem schmerzhaften Rigor. Zur Schmerzeinstellung sollte hier eine optimale Einstellung mit L-Dihydroxphenylalanin (L-DOPA) oder DOPA-Agonisten erfolgen. Die Schmerzbehandlung sollte sich immer auch an den psychischen, sozialen und spirituellen Bedurfnissen des Patienten ausrichten.

Cancer pain and pain associated with non-neoplastic diseases can be associated with pain mechanisms, such as a peripheral or central sensitization or deafferentation. The clarification allows indirect conclusions about the underlying mechanisms based on clinical signs, such as allodynia or hyperalgesia. Non-opioid analgesics are the basis of cancer pain therapy according to the World Health Organization (WHO) pain ladder. In the case of severe cancer pain, treatment can be escalated directly from level 1 to level 3. Opioids are highly effective for the treatment of cancer pain even with a neuropathic component, which can occur in up to 40 % of cases as amixed pain syndrome. Coanalgesics represent a valuable therapeutic adjunct for better pain control and can address treatment of comorbidities, such as anxiety, depression and sleep disorders. When liver and/or renal function is reduced, the dosage of many drugs has to be adapted. Treatment of multimorbid or critically ill patients with opioids and antidepressants/anticonvulsants requires consideration of numerous possible pharmacodynamic and pharmacokinetic interactions.

To date, no studies investigating titration with oral transmucosal fentanyl for the dose-finding of transdermal fentanyl treatment have been published. In an open randomized study 60 patients with chronic malignant (n = 39) or nonmalignant pain (n = 21), who required opioid therapy according to step three of the guidelines of the World Health Organization (WHO), were investigated. In two groups of 30 patients each titration with immediate release morphine (IRM) or oral transmucosal fentanyl citrate (OTFC) was undertaken. For measurement purposes the Brief Pain Inventory (BPI) and Minimal Documentation System (MIDOS) were used. After a 24-h titration phase, in which patients documented the intensity of pain, nausea, and tiredness, treatment with transdermal fentanyl was evaluated over a 10-day period by means of the necessary dose adaptation (responder ≤ 1 dose adaptation; conversion formula 1:1 [OTFC group] vs 100:1 [IRM group]).The pain reduction over the first 24 h (titration phase) did not differ significantly between the groups. The number of responders (17 OTFC vs. 21 IRM) over the 10-day period did not show any difference either. In both groups there was a significant reduction in pain intensity (p 0.001). Over the course of the study, there were significantly more drop-outs because of adverse effects in the OTFC group than in the IRM group (8 vs 1, p = 0.028).Oral transmucosal fentanyl citrate can be applied for the titration of transdermal fentanyl, but it does not show any clinically relevant advantage. For example, the risk of side effects-induced drop-outs was greater in the present study. Whether the unnecessary opioid switching to treat chronic pain and breakthrough pain is advantageous with regard to minimizing conversion errors cannot be definitively answered within the scope of this study.

Palliative medicine focuses on relieving burdening symptoms to improve quality of life. The most common symptoms are physical weakness, pain, loss of appetite, nausea as well as dyspnea, itching and depression. Frequently, good symptom control can be achieved using the most effective drug combination therapy or non-medicinal interventions. This article specifically addresses the physical symptoms dyspnea, itching and the psychological symptom depression.

The Drug Commission of the German Medical Association has decided to develop treatment guidelines for palliative care. A series of systematic reviews was commissioned to evaluate the evidence for interventions of common symptoms that burden patients and care givers. A common methodology for all reviews is described in this paper. The methodology was based on the work of the European Palliative Care Research Collaborative. Standardized search strategies were identified in PubMed and Embase and these templates were then adapted by the authors of the reviews according to their needs. The template included the target group (patients and disease entities), indications (symptoms) and interventions (medicines and classes of medicines). Target groups included search terms on palliative or hospice care, cancer, neurodegenerative diseases, HIV/AIDS as well as cardiac and pulmonary failure. The number of relevant hits was surveyed in the first 40 hits in some exemplary searches. This was used for fine tuning the search templates and to optimize the search strategy in order to achieve the highest possible yield with the minimum possible effort. The review series was performed using this search strategy. Every review graded the quality of the included evidence following categories of the Drug Commission of the German Medical Association. Based on these results and recommendations the treatment guidelines will be formulated which will offer concise and evidence-based guidelines for general palliative medicine, offering primary care givers guidance for adequate palliative care in severely ill and dying patients. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").

Background The therapy of tiredness, weakness and fatigue in palliative care patients is of growing interest. Glucocorticoids and androgens are habitually mentioned drugs for treatment. In this review evidence for glucocorticoids and androgens for these indications in palliative care patients are presented. Materials and methods A systematic search of PubMed and Embase for studies on glucocorticoids and androgens for fatigue, asthenia, sedation, tiredness, weakness, exhaustion, cachexia, drowsiness and wasting in palliative care was carried out in August 2011. Furthermore, the Cochrane Library, references from the literature and leading textbooks were also searched. Study information was entered in a standardized extraction sheet. By a categorization of studies five endpoints were distinguished: fatigue, strength/weakness, tiredness, well being/quality of life and energy/activity/performance. Results A total of 11 controlled studies with glucocorticoids and 13 controlled studies with androgens were included. In addition four uncontrolled studies, two case series and two surveys with glucocorticoids as well as six uncontrolled studies and one case series with androgen treatment were analyzed. All controlled trials of glucocorticoids were performed in cancer patients and all but one controlled trial of androgens in patients with HIV/AIDS. Glucocorticoids improved quality of life but results for changes of fatigue and weakness were inconsistent. Tiredness and energy were not improved. Androgens had a positive effect on fatigue and quality of life and showed variable effects on weakness. Androgens did not improve energy. Side effects were frequently documented but only rarely resulted in discontinuation of therapy. Conclusion With the existing evidence no general recommendation for glucocorticoid and androgen use in tiredness and weakness in palliative care patients can be given; however, glucocorticoids in cancer patients and androgens in HIV positive-patients can be used in an individual trial for improving patient quality of life. The use in patients suffering from other disease entities should be evaluated in randomized controlled trials with a similar setting. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").

ZusammenfassungDas diagnostische „Work-up“ neuropathischer Schmerzen umfasst Schmerzfragebögen als Screening-Instrumente sowie eine Schmerzzeichnung, Informationen zur Krankheitsgeschichte und eine klinisch-neurologische Untersuchung zur Klärung der Fragen: Ist das Screening zur Ausprägung von Schmerzdeskriptoren vereinbar mit dem Vorliegen eines neuropathischen Schmerzes? Ist das Muster der Schmerzausbreitung und des sensiblen Defizits neuroanatomisch nachvollziehbar? Finden sich Hinweise auf eine relevante Läsion oder Erkrankung der peripheren oder zentralen Anteile des somatosensorischen Systems? Als Ergänzung zur elektrophysiologischen Untersuchung des somatosensorischen Systems hat sich als komplementäres Verfahren die quantitative sensorische Testung etabliert, die anders als konventionelle Verfahren neben sensiblen Defiziten die Erfassung sensibler Pluszeichen erlaubt. Klinische Pluszei-chen wie Hyperalgesie, Hyperpathie und Allodynie oder Minuszeichen wie Hypästhesie und Hypoalgesie können dabei auf dem Schmerz zugrunde liegende neurobiologische Mechanismen hinweisen, wie eine periphere, zentrale Sensibilisierung oder Deafferenzie-rung im nozizeptiven System.

Hintergrund Die Einfuhrung der Palliativmedizin in Pflegeeinrichtungen wurde in den letzten Jahren zunehmend gefordert. Fur die Implementierung der Palliativversorgung in stationaren Pflegeheimen und anderen Einrichtungen stellt die Evaluation der Implementierungsmasnahmen eine grose Herausforderung dar. Eine quantitative Messung sollte aufgrund der hohen Komplexitat des Gegenstands v. a. auf das Wissen in Bezug auf Palliativversorgung abzielen. Zusatzlich kann die spezifische Selbstwirksamkeit Auskunft uber die Umsetzung des Wissens geben. Fur beide Bereiche gibt es bislang noch keinen Test in deutscher Sprache.

Quantitative sensory testing (QST) is a standardized and formalized set of clinical sensitivity tests based on subjective (psychophysical) methods, which depends on the cooperation of the subject being investigated. Calibrated stimuli are used to measure the perception and pain thresholds, which provide information on the presence of sensory plus or minus signs. The QST equipment presented mimics natural thermal or mechanical stimuli. The rationale is to test for patterns of functional sensory loss or gain by simultaneous assessment of both cutaneous and deep pain sensitivity. The majority of QST parameters are normally distributed only after logarithmic transformation (i.e. secondary normalization). With QST a complete somatosensory profile can be obtained within 1 h. The QST is a suitable method for characterizing the function of the somatosensory system in clinical trials and also in clinical practice as a diagnostic procedure.

In functional imaging studies, the insular cortex (IC) has been identified as an essential part of the processing of a whole spectrum of multimodal sensory input. However, there are no lesion studies including a sufficient number of patients, which would reinforce the functional imaging data obtained from healthy subjects. Such lesion studies should examine how damage to the IC affects sensory perception. We chose acute stroke patients with lesions affecting the IC in order to fill this gap.A comprehensive sensory profiling by applying a quantitative sensory testing protocol was performed and a voxel-lesion behaviour mapping analysis in 24 patients with acute unilateral cortical damage was applied.Our data demonstrate that patients with lesions of the posterior IC have deficits in temperature perception, but did not show other sensory deficits such as hot or cold pain perception associated with specific lesion locations.Our data allow the conclusion that the posterior IC may represent the major region responsible for encoding warm and cold perception in the brain. To what extent focal IC lesions may also impair pain processing or induce post-stroke pain has to be addressed in future studies including more patients.

With a priority programme the German Cancer Aid supported the development of quality-assured outpatient palliative care to cover the whole country. The 12 regional pilot projects funded with the aim to improve outpatient palliative care in different models and different frameworks were concurrently monitored and evaluated.The supported projects, starting and ending individually, documented all patients who were cared for using HOPE (Hospice and palliative care evaluation) and MIDOS (Minimal documentation system for palliative patients). Total data were analyzed for 3239 patients decriptively. In addition to the quantitative data the experiences of the projects were recorded in a number of workshops (2008, 2009, 2010, and 2012). In particular, the experiences reported in the final meeting in July 2012 were considered for this article as well as the final reports for the German Cancer Aid.In the quantitative evaluation 85.6% of 3239 palliative care patients had a cancer diagnosis. In all model projects the goal of a network with close cooperation of primary providers, social support, and outpatient and inpatient specialist services has been achieved. For all projects, the initial financing of the German Cancer Aid was extremely important, because contracts with health insurance funds were negotiated slowly, and could then be built on the experiences with the projects.The participants of the project-completion meeting emphasized the need to carry out a market analysis before starting palliative care organizations considering the different regional structures and target groups of patients. Education, training and continuing education programs contribute significantly to the network. A reliably funded coordination center/case management across all institutions is extremely important.

Palliative care patients do not only suffer from cancer pain but also from painful muscle spasticity due to multiple sclerosis, amyotrophic lateral sclerosis, after stroke or due to dementia if damage of the pyramidal motor system is present. Centrally active muscle relaxants can be helpful also when used as coanalgesics for cancer pain. In addition to opioids other coanalgesics, such as tricyclic antidepressants or serotonin/noradrenalin reuptake inhibitors as well as anticonvulsants (sodium channel and calcium channel blockers) can be helpful if neuropathic cancer pain is present. Idiopathic Parkinsonism or multiple system atrophy leads more to a painful rigor and pain control should be supported here by optimal adjustment of L-DOPA or DOPA agonist therapy. However, pain treatment should always address the psychological, social and spiritual demands of the patient.

The therapy of tiredness, weakness and fatigue in palliative care patients is of growing interest. Glucocorticoids and androgens are habitually mentioned drugs for treatment. In this review evidence for glucocorticoids and androgens for these indications in palliative care patients are presented.A systematic search of PubMed and Embase for studies on glucocorticoids and androgens for fatigue, asthenia, sedation, tiredness, weakness, exhaustion, cachexia, drowsiness and wasting in palliative care was carried out in August 2011. Furthermore, the Cochrane Library, references from the literature and leading textbooks were also searched. Study information was entered in a standardized extraction sheet. By a categorization of studies five endpoints were distinguished: fatigue, strength/weakness, tiredness, well being/quality of life and energy/activity/performance.A total of 11 controlled studies with glucocorticoids and 13 controlled studies with androgens were included. In addition four uncontrolled studies, two case series and two surveys with glucocorticoids as well as six uncontrolled studies and one case series with androgen treatment were analyzed. All controlled trials of glucocorticoids were performed in cancer patients and all but one controlled trial of androgens in patients with HIV/AIDS. Glucocorticoids improved quality of life but results for changes of fatigue and weakness were inconsistent. Tiredness and energy were not improved. Androgens had a positive effect on fatigue and quality of life and showed variable effects on weakness. Androgens did not improve energy. Side effects were frequently documented but only rarely resulted in discontinuation of therapy.With the existing evidence no general recommendation for glucocorticoid and androgen use in tiredness and weakness in palliative care patients can be given; however, glucocorticoids in cancer patients and androgens in HIV positive-patients can be used in an individual trial for improving patient quality of life. The use in patients suffering from other disease entities should be evaluated in randomized controlled trials with a similar setting. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").

The Drug Commission of the German Medical Association has decided to develop treatment guidelines for palliative care. A series of systematic reviews was commissioned to evaluate the evidence for interventions of common symptoms that burden patients and care givers. A common methodology for all reviews is described in this paper. The methodology was based on the work of the European Palliative Care Research Collaborative. Standardized search strategies were identified in PubMed and Embase and these templates were then adapted by the authors of the reviews according to their needs. The template included the target group (patients and disease entities), indications (symptoms) and interventions (medicines and classes of medicines). Target groups included search terms on palliative or hospice care, cancer, neurodegenerative diseases, HIV/AIDS as well as cardiac and pulmonary failure. The number of relevant hits was surveyed in the first 40 hits in some exemplary searches. This was used for fine tuning the search templates and to optimize the search strategy in order to achieve the highest possible yield with the minimum possible effort. The review series was performed using this search strategy. Every review graded the quality of the included evidence following categories of the Drug Commission of the German Medical Association. Based on these results and recommendations the treatment guidelines will be formulated which will offer concise and evidence-based guidelines for general palliative medicine, offering primary care givers guidance for adequate palliative care in severely ill and dying patients. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").

Methods 50 patients with cNP (age 53.3 ± 10.4 yrs) were examined at baseline and then randomized to treatment (TG) or standard medical care (SMC). Data were collected at baseline (T1) and T2 (for TG after treatment). TG received five treatment sessions of CM, while the SMC group was waiting. Subjective outcome measures included visual analogue scale for pain (VAS), Neck Pain Disability Index (NDI), and quality of life (SF36). Neurophysiologic testing included Quantitative Sensory Testing subtests mechanical detection threshold (MDT), pressure pain threshold (PPT), vibration threshold (VDT) and two-point discrimination (2PD) at the point of maximum pain (Pmax), close to maximum pain (Pclose), and hand and foot as control areas. ANCOVA analyses were conducted across post-pre differences with baseline values as covariates.

During the course of cancer progression up to 90% of the patients suffer from pain of nociceptive, neuropathic or mixed nociceptive/neuropathic origin. Psychological, social or existential factors may additionally affect the intensity of pain (concept of "total pain"). The WHO "analgesic ladder" provides a large variety of effective drugs that can be used according to the specific pain type. Parenteral or peridural opioid therapy as well as neurodestructive methods can effectively support the analgesic treatment in selected cases.

Palliative care in nursing homes has become an increasing focal point of healthcare in Germany and the evaluation of the specific quality of palliative care in this setting is under discussion. The assessment of quantitative data has the advantage of allowing pre-post comparisons of different interventions and implementation procedures and can therefore be used for evaluation of effectiveness. However, no assessment tool in German is available yet. Recent research on the assessment of healthcare professionals' knowledge indicated that knowing about technical and psychosocial aspects of palliative care is an easily measurable index for the quality of care. In consequence this index will be used as the core of the test instrument. The specific self-efficacy related to palliative care should be additionally included.An analysis of the two most common tests of palliative care knowledge by three experts revealed that these instruments were only partly useful in Germany because of differences in the healthcare systems. The experts also criticised that the tests included only a few items concerning psychosocial care and that these items often showed ceiling effects. In addition, the instruments were not suitable for use in nursing homes. For specific self-efficacy only one test is available in Dutch. The items of these three instruments were face validated by 5 experts and new items were generated where needed. The content validity was verified again by five experts with the think-aloud method. Items were validated in 23 calliative care trainers whose expert knowledge served as an external criterion. Items that scored low in this group were eliminated. A second sample of 36 assistant nurses working in nursing homes who took part in a workshop for palliative care was used to assess change sensitivity before and after training.A total of 23 items for the knowledge test and 15 items for specific self-efficacy were selected. The level of difficulty was suitable because an expert group could answer the questions while for assistant nurses the items were sufficiently difficult to show a difference between groups. Items were very sensitive to change after a training course.The BPW is the first standardized test instrument for palliative care in the German language. In comparison to the other tests it includes items from the psychosocial domain without demonstrating a ceiling effect for these items. Content and criterion validity were good. Additional tests with larger samples and with other groups of nurses working in other settings would be needed to improve the data on reliability and to extend the validation to other settings.

Fragestellung: Tumorschmerzen zeigen eine neuropathische Komponente, wenn im Verlauf von Tumorwachstum oder Therapie eine Schadigung des somatosensorischen Systems auftritt. Ziel der Untersuchung war die Frage, ob mit verschiedenen Testverfahren wie einer klinisch-neurologischen Untersuchung, einem Screening-Fragebogen (PAINdetect) und einer detaillierten quantitativen sensorischen Testung (QST) das Vorhandensein eines neuropathischen Schmerzes mit gleicher Sensitivitat festgestellt werden kann. Methoden: Wir erfassten konsekutiv Patienten der Interdisziplinaren Einrichtung fur Palliativmedizin in Mainz. Eingeschlossen wurden alle Patienten mit Schmerzen, die in der Lage waren, den Schmerzfragebogen und die Instruktionen der QST zu verstehen und bereit zur Studienteilnahme waren. Diese Patienten wurden einer klinisch-neurologischen Untersuchung unterzogen. Mittels PAINdetect-Schmerzfragebogen wurden eine Schmerzzeichnung sowie die Auspragung von 7 Schmerzdeskriptoren erhoben. Im schmerzhaften Areal und einem Kontrollareal folgte eine quantitative sensorische Testung. Entsprechend dem QST Protokoll des Deutschen Forschungsverbunds Neuropathischer Schmerz (DFNS) wurden 13 thermische und mechanische Wahrnehmungs- und Schmerzschwellen bestimmt und bezogen auf Referenzdaten gesunder Kontrollpersonen beurteilt. Mithilfe der genannten Verfahren wurden die Schmerzen als nozizeptiv, neuropathisch oder ohne eindeutige Zuordnung (unklar) klassifiziert. Ergebnisse: 34 von 56 konsekutiv aufgenommenen Patienten berichteten Schmerzen als aktuelles Hauptsymptom (60,7%). Davon erfullten 12 Patienten die Einschlusskriterien. Das durchschnittliche Alter der 12 Studienpatienten betrug 60,3±10,3 Jahre (75% Frauen) mit einem mittleren ECOG-Score von 2,5±0,9 (MW±SD). Nach dem Neurostatus war bei 7 von 12 Patienten (58,3%) eine zusatzliche neuropathische Schmerzkomponente wahrscheinlich. Nach der QST zeigten 6 von 12 Patienten (50%), nach dem PAINdetect-Fragebogen 3 von 12 Patienten (25%) einen neuropathischen Schmerz. Neurostatus und QST korrelierten signifikant (r=0,66; p=0,02). PAINdetect korrelierte weder mit dem Neurostatus noch der QST. Schlussfolgerung: Die vorlaufigen Ergebnisse der laufenden Studie zeigen eine Assoziation von Neurostatus und QST, die belegt, dass QST als standardisierte und formalisierte quantitative klinische Sensibilitatsprufung gut mit der klassischen qualitativen neurologischen Untersuchung ubereinstimmt. Die fehlende Korrelation von Neurostatus/QST und PAINdetect weist darauf hin, dass eine sorgfaltige korperliche Untersuchung nicht durch einen Screening–Fragebogen bei diesem Patientenkollektiv mit Tumorschmerz ersetzt werden kann.