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Cancer patients are facing a variety of treatment and other disease-related decisions. This study aims to provide insights into preferred and perceived participation roles in decision-making among patients with diverse tumors using the German Cancer Information Service (CIS).Patients' decision-making preferences and experiences were assessed as a part of a cross-sectional survey among CIS users. An adapted version of the Control Preferences Scale (CPS) was used to assess preferred and perceived participation roles in eight different areas of medical decision-making (e.g., choice of medication, termination of treatment). Logistic regression analyses were applied to explore preference matching and to analyze associations between participation roles and sociodemographic variables. Moreover, we examined preferences and perceptions of participation roles across different decision situations.In the final sample (N = 1566, 64.9% female, mean age = 61.6), almost half of the patients (47.1%) preferred to take a collaborative role in decisions on treatment methods, whereas 36.3% preferred an active role and 15.9% a passive role. Collaborative role preferences frequently (40.7%) coincided with experiencing a passive role and predicted a reduced chance of a match between preferences and experiences (OR = 0.57, p = .001). A higher level of education was associated with a lower chance of preferring and perceiving a passive role (OR = 0.85, p .01). Compared with men, women had increased odds of preferring (OR = 1.45, p .05) and of actually taking (OR = 2.04, p .001) a passive role in medical encounters. Preferred participation roles regarding treatment methods were highly correlated with preferences in all other decision areas (r .50, p .001) except decisions about family involvement.The study reveals well-known deficits in the fulfilment of patients' collaborative role preferences across different areas of medical decision-making in a sample of CIS users characterized by high information-seeking behavior. Participation roles were not only influenced by the patients' level of education but also by their gender. The gender effect may be more pronounced than previous studies suggest. These effects should be considered in the development of interventions to promote shared decision-making. Additionally, study results indicate that preferences for participation in decisions about treatment methods, as assessed by the CPS, can be generalized to other areas of medical decision-making.

Obwohl die Aufmerksamkeit unter den Ärztinnen und Ärzten in Bezug auf chronische Schmerzen wächst, gilt der Patient mit chronischen Schmerzen in der Praxis oftmals als komplexer, wenn nicht sogar „schwieriger“ Patient. Patienten mit chronischen Schmerzen sind damit dem erhöhten Risiko ausgesetzt, vorschnell abgewiesen und weitergeschickt zu werden. Gleichzeitig sind die therapeutischen Möglichkeiten oftmals begrenzt und die Therapieerfolge unbefriedigend.

Although psychosocial factors have a profound impact on the experience of pain and pain recovery, the transfer to clinical application has so far been insufficient. With this article, a task force of the special interest group "Psychosocial Aspects of Pain" of the German Pain Society (Deutsche Schmerzgesellschaft e. V.) would like to draw attention to the considerable discrepancy between existing scientific evidence on the importance of psychosocial factors in the development of chronic pain disorders and the translation of these findings into the care of pain patients. Our objective is a stronger integration of psychological and psychosomatic expertise in pain treatment and research, as well as the improvement of structural and institutional conditions, to achieve an increased consideration of psychosocial aspects. In this way, modern, integrative and complex pain concepts can reach the patient. Based on these fundamental findings on the importance of psychosocial factors in pain and pain treatment, implications for the transfer to clinic and further research will be shown.Psychosoziale Faktoren beeinflussen Schmerzerleben und Schmerzgenesung weitreichend, trotzdem ist der Transfer in die klinische Anwendung bisher unzureichend. Mit diesem Beitrag möchte eine Arbeitsgruppe des Arbeitskreises „Psychosoziale Aspekte bei Schmerz“ der Deutschen Schmerzgesellschaft e. V. auf die erhebliche Diskrepanz zwischen bestehender wissenschaftlicher Evidenz zur Bedeutung psychosozialer Faktoren bei der Entstehung chronischer Schmerzstörungen und der Translation dieser Ergebnisse in die Versorgung von Schmerzpatienten aufmerksam machen. Unsere Ziele sind eine stärkere Integration psychologischer und psychosomatischer Expertise in die Schmerzbehandlung und -forschung sowie die Verbesserung der strukturellen und institutionellen Voraussetzungen, um zu einer vermehrten Berücksichtigung psychosozialer Aspekte zu kommen. Nur so können die modernen, integrativen und komplexen Schmerzkonzepte beim Patienten ankommen. Basierend auf diesen grundlegenden Erkenntnissen zur Bedeutung psychosozialer Faktoren bei Schmerz und Schmerzbehandlung sollen Implikationen für den Transfer in die Klinik und die weitere Forschung aufgezeigt werden.

Background The majority of knowledge about fibromyalgia syndrome (FMS) derives from studies of female patients. Little is known about the clinical characteristics and treatment outcomes of male FMS patients. Objective We investigated whether male FMS patients differ from female patients in terms of 1.) symptom burden, 2.) psychological characteristics, and 3.) clinical treatment response. Methods For this retrospective cohort study with a prospective posttreatment-follow-up, we identified 263 male (4%) out of 5,541 FMS patients completing a three-week multimodal pain-treatment program. Male FMS patients (51.3±9.1 years) were age- and time-matched (1:4) with female FMS patients (N = 1052, 51.3±9.0 years). Data on clinical characteristics, psychological comorbidities and treatment response were obtained from medical records and validated questionnaires. Results Levels of perceived pain, psychological comorbidity, and functional capacity were similar between genders, although male FMS patients showed a higher prevalence for alcohol abuse. Compared to female patients, male FMS patients experienced themselves less often as overly accommodating (Cohen’s d=-0.42), but more often as self-sacrificing (d = 0.26) or intrusive (d = 0.23). Regarding pain coping, male patients were less likely to utilize mental distraction, rest- and relaxation techniques, or counteractive activities (d = 0.18–0.27). Male FMS patients showed a slightly worse overall response rate than women (69% vs. 77%), although differences between individual outcome measures were small (d

Background Patients with metastatic melanoma and their physicians are confronted with a complex decision regarding first-line therapy. Risks and benefits vary considerably between various treatment options. With this in mind, we aim to develop and evaluate a patient decision aid (PtDA) to inform patients about the risks and benefits of treatment options, namely, immunotherapy as monotherapy, immunotherapy as combination therapy, and treatment with BRAF/MEK inhibitors. We aim to test whether the use of this PtDA before medical consultation will increase patients’ knowledge of treatment options and thus promote shared decision-making (SDM) and patient decision satisfaction. Methods In total, 128 patients with metastatic melanoma from two German cancer centers will be randomized to the intervention group (IG), receiving access to the PtDA before medical consultation, or the control group (CG), receiving treatment as usual (TAU), i.e., medical consultation alone. There will be three major assessment points (before intervention, T0; after intervention, T1; and 3 months after intervention, T2). The main outcome is the patient’s knowledge of their treatment options, measured by a self-developed, piloted multiple-choice test at T1. Secondary outcome measures will include the extent of SDM during medical consultation, assessed by Observer OPTION 5, and patient decision satisfaction, assessed by the Satisfaction with Decision Scale (SwD), at T1 and T2. Discussion This trial will assess the effectiveness of a developed PtDA to enhance patient knowledge of treatment options for metastatic melanoma, SDM, and patient decision satisfaction. If the efficacy can be proven, the PtDA will be implemented nationwide in Germany to close a relevant gap in the education and care of patients with metastatic melanoma. Trial registration ClinicalTrials.gov NCT04240717. Registered on 27 January 2020

Although there is growing awareness among physicians regarding chronic pain, the patient with chronic pain is often considered a complex, if not "difficult" patient in practice. Patients with chronic pain are thus at increased risk of being hastily dismissed and sent on their way. At the same time, therapeutic options are often limited and therapeutic successes not satisfying.Obwohl die Aufmerksamkeit unter den Ärztinnen und Ärzten in Bezug auf chronische Schmerzen wächst, gilt der Patient mit chronischen Schmerzen in der Praxis oftmals als komplexer, wenn nicht sogar „schwieriger“ Patient. Patienten mit chronischen Schmerzen sind damit dem erhöhten Risiko ausgesetzt, vorschnell abgewiesen und weitergeschickt zu werden. Gleichzeitig sind die therapeutischen Möglichkeiten oftmals begrenzt und die Therapieerfolge unbefriedigend.

OBJECTIVES The relationship between changes in symptom severity and health-related quality of life (HRQOL), which may be impacted by stressful life events, in irritable bowel syndrome (IBS), is unclear. Therefore, we investigated the relationship between changes in symptom severity and HRQOL and examined the moderating role of stressful life events in patients with IBS. METHODS This study is part of a cohort follow-up study on psychological factors in patients with IBS in tertiary care, and it included 158 patients. In addition to symptom severity and HRQOL, stressful life events were assessed by the Social Readjustment Rating Scale (SRRS). The relationship between symptom severity and HRQOL and the moderating role of stressful life events (in the 12 mo before the follow-up assessment) were analyzed. RESULTS The majority of participants had moderate levels of stressful life events (41.8%), followed by those who had mild levels (39.2%) and severe levels (19.0%) of stressful life events. Symptom severity could predict HRQOL, and the relationship between symptom severity and HRQOL was affected by the level of stressful life events. Compared with mild levels of stressful life events, a severe level of stressful life events significantly affected the relationship between changes in symptom severity and HRQOL (Z=-3.048, P

The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.

The question of pain prevention is becoming increasingly important, both in society and in science. According to the International Society for the Study of Pain, general areas for which pain prevention measures can be recommended have been defined. These approaches are mostly limited to unspecific recommendations with the aim of improving general health behaviour. Common to all of them is that they essentially address psychosocial and psychobehavioral aspects. In contrast to genetic factors or other non-modifiable environmental factors, psychosocial and psychobehavioral aspects are potentially modifiable variables, making them possible starting points for prevention programs. Furthermore, recent studies provide important knowledge about psychological and social risk factors of pain chronification and thus offer new approaches for future pain prevention strategies. At the same time, the efficacy and successful implementation of such programs is so complex that valid statements on effectiveness and benefit can only be made through care-related evaluation. This review addresses psychological and social factors in the prevention of pain. A selective literature search was carried out to this end. Based on selected studies, psychological and social predictors of pain development are presented and their potential for future pain prevention programs discussed. The article concludes with a discussion of possible implications.Die Frage der Schmerzprävention gewinnt sowohl gesellschaftlich als auch in der Wissenschaft zunehmend an Bedeutung. Entsprechend der Internationalen Gesellschaft zum Studium des Schmerzes wurden allgemeine Bereiche definiert, für die schmerzpräventive Maßnahmen empfohlen werden können. Diese Ansätze beschränken sich meist auf unspezifische Empfehlungen mit dem Ziel, das allgemeine Gesundheitsverhalten zu verbessern. Allen gemeinsam ist, dass sie im Wesentlichen psychosoziale und psychobehaviorale Aspekte umfassen. Im Gegensatz zu genetischen Faktoren oder anderen nicht veränderbaren Umweltfaktoren sind diese Aspekte meist potenziell veränderbare Variablen, weshalb sie mögliche Ausgangspunkte für Präventionsprogramme darstellen. Ferner liefern neuere Studien wichtiges Wissen über psychologische und soziale Risikofaktoren der Schmerzchronifizierung und bieten damit neue Ansätze für zukünftige Schmerzpräventionsstrategien. Gleichzeitig sind die Wirkung, Modifikation und erfolgreiche Implementierung solcher Programme so komplex, dass letztendlich nur durch die versorgungsbezogene Evaluation valide Aussagen über Wirksamkeit und Nutzen gemacht werden können. Im Rahmen der vorliegenden Übersichtsarbeit soll auf psychologische und soziale Faktoren in der Prävention von Schmerz eingegangen werden. Hierfür wurde eine selektive Literaturrecherche durchgeführt. Anhand ausgewählter Studien werden psychologische und soziale Prädiktoren für die Schmerzentstehung kurz umrissen und deren Potenzial für zukünftige Schmerzpräventionsprogramme diskutiert. Der Beitrag schließt mit einer Diskussion über mögliche Implikationen.

Objective The detrimental impact of nonspecific chronic low back pain (CLBP) on quality of life is well known. However, patients with CLBP represent a remarkably heterogeneous group, and not all of them report compromised well-being. Methods In this study, we investigated this heterogeneity by identifying profiles (or clusters) of well-being and their correlates in 239 CLBP patients. To take the multidimensionality of subjective well-being into account, we included multiple well-being indicators (depression, anxiety, affective distress, perceived control over life). For an in-depth characterization of the well-being profiles, we assessed 1) sociodemographic indicators (age, gender, education, marital status, occupational status), 2) pain-related measures (pain intensity, subjective and objective pain disability, number of pain locations), 3) psychosocial resources (mental health, resilience, perceived support), 4) biographical factors (trauma), and 5) somatosensory profiles based on quantitative sensory testing. Results Based on two-step cluster analysis, we identified three distinct well-being profiles, characterized by either generally high well-being (cluster 1, n = 51), moderate well-being (cluster 2, n = 104), or consistently low well-being (cluster 3, n = 77), respectively. Most differences between the derived well-being profiles regarding sociodemographic, psychosocial, and biographical measures were of weak to moderate effect size. Larger effect sizes were observed for differences in pain intensity and subjective, but not objective, pain disability. Finally, the largest effects were found for differences in psychosocial resources. Conclusions Our findings suggest that not only in nonclinical samples, but also in patients with chronic pain, well-being is more closely associated with psychological resources and subjective evaluations than with objective parameters.

Das Schmerzempfinden des Erwachsenen wird in der fruhen Kindheit durch Wechselwirkungen zwischen Psyche, Korper und der sozialen Umgebung substanziell gepragt. Fruhkindliche Stresserfahrungen und traumatisierende Lebensereignisse fuhren zu neuroendokrinen und psychophysischen Stressreaktionen, die uber multiple neurofunktionelle Vorgange einen bleibenden Einfluss auf die biologischen und psychologischen Prozesse der Schmerzwahrnehmung und Schmerzverarbeitung ausuben. Im Rahmen dieser Ubersichtsarbeit soll auf die komplexen Zusammenhange zwischen traumatischen Stresserfahrungen und damit assoziierten psychobiologischen Mechanismen der Schmerzchronifizierung eingegangen werden. Anhand ausgewahlter Studien werden psychophysiologische Veranderungen in dieser Subgruppe von Patienten vorgestellt und mogliche zugrunde liegende Mechanismen diskutiert. Der Artikel schliest mit einer Diskussion uber mogliche Implikationen fur die Behandlung.

ZusammenfassungDer Artikel gibt einen Überblick über das Konzept der Partizipativen Entscheidungsfindung (PEF), das von vielen Akteuren des Gesundheitssystems als besonders günstige Form der Arzt-Patient-Interaktion verstanden wird. Die PEF wird abgegrenzt gegen weitere Modelle der Arzt-Patient-Interaktion wie das Paternalistische Modell und das Informationsmodell. Neben den Akzeptanzwerten von PEF in der Bevölkerung und unter Ärzten wird auch auf mögliche Barrieren in der Umsetzung eingegangen. Anwendungsbereiche für die PEF werden besprochen und Strategien sowie Hilfsmaterialien zur Umsetzung im individuellen Arzt-Patient-Kontakt dargestellt und anhand eines onkologischen Fallbeispiels vertieft. Effekte der PEF für Patienten und für Behandler werden aufgezeigt. Nach Eingehen auf wichtige Quellen von PEF erfolgt die Einordnung vor dem aktuellen gesundheitspolitischen Hintergrund in Deutschland.

Objective Nonspecific chronic low back pain (CLBP) is a frequent medical condition among middle-aged and older adults. Its detrimental consequences for functional ability and quality of life are well known. However, less is known about associations of chronological age with disability and well-being among CLBP patients. Coping with pain may be harder with advancing age due to additional age-associated losses of physical, sensory, and other resources, resulting in higher disability and lower quality of life. Alternatively, older patients may feel less impaired and report higher quality of life than younger patients because the experience of chronic pain may be better anticipated and more “normative” in old age. Methods We investigated an age-heterogeneous sample of 228 CLBP patients (mean age = 59.1 years, SD = 10.2 years, range 41–82 years). Our outcomes were pain intensity, pain disability (as assessed by self-reported activity restrictions and performance-based tests), and measures of quality of life (health-related quality of life: SF-12 physical and mental health; well-being: anxiety, depression, perceived control over life, affective distress). Results Although older patients had higher performance-based disability, they scored higher on mental health and on most measures of well-being than younger patients. Conclusions Our findings provide evidence for a “paradoxical” pattern of age effects in CLBP patients and are thus in line with other studies based on nonclinical samples: Although disability in CLBP patients increases with advancing age, indicators of quality of life are equal or even higher in older patients.

Die planmasige Aktualisierung der S3-Leitlinie „Fibromyalgiesyndrom“, AWMF-Registernummer 145/004, war fur April 2017 geplant. Die Leitlinie wurde unter Koordination der Deutschen Schmerzgesellschaft von dreizehn Fachgesellschaften und zwei Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 42 Mitgliedern wurden ausgewogen in Bezug auf Geschlecht, medizinischen Versorgungsbereich, potenzielle Interessenkonflikte und hierarchische Position im medizinischen bzw. wissenschaftlichen System besetzt. Die Literaturrecherche erfolgte uber die Datenbanken MEDLINE, PsycINFO, Scopus und Cochrane Library (von Dezember 2010 bis Mai 2016). Die Graduierung der Evidenzstarke erfolgte nach dem Schema des Oxford Centre for Evidence-Based Medicine, Version 2009. Die Formulierung und Graduierung der Empfehlungen erfolgte in einem mehrstufigen, formalisierten Konsensusverfahren. Der Leitlinie wurde von den Vorstanden der beteiligten Fachgesellschaften nach Uberprufung zugestimmt. Die klinische Diagnose des Fibromyalgiesyndroms kann sowohl nach den Klassifikationskriterien des American College of Rheumatology (ACR) von 1990 (mit Untersuchung der „tender points“) als auch ohne Untersuchung von „tender points“ anhand der modifizierten vorlaufigen diagnostischen Kriterien des ACR von 2010 bzw. der 2011-Kriterien erfolgen.

Objective The purpose of this study was to investigate key factors related to lifestyle changes following acute myocardial infarction (AMI) by eliciting survivors’ subjective needs for, attitudes towards and experiences with behaviour changes in their everyday life to improve future interventions promoting lifestyle changes. Methods Semi-structured interviews were conducted with 21 individuals who had recently experienced an AMI. The interviews were audio-recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results The data analysis revealed that lifestyle changes following AMI are influenced by a combination of individual (physical and psychological) and social factors that can be grouped into facilitators and barriers. The interviews indicated the need for more personalised information regarding the causes and risk factors of illness, the benefits of lifestyle changes and the importance of including significant others in lifestyle advice and education and of individualising support. Discussion Lifestyle change is a continuous process that is not completed within a few months after a cardiac event. Considering the identified themes when developing interventions to promote lifestyle changes following AMI may enhance the effectiveness and sustainability of such interventions.

There has been a surging interest in the putative role of peripheral growth factors in the pathophysiology of fibromyalgia, specifically in the peripheral sensitization that occurs in chronic pain disorders. This cross-sectional study set out to assess and compare brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in plasma samples from fibromyalgia patients and healthy controls. Plasma BDNF and NGF were measured in 89 fibromyalgia patients and 36 pain-free controls, and compared using ANCOVA controlling for potential confounders, as well as Bayesian methods for parameter estimation and model evaluation. BDNF and NGF levels in fibromyalgia patients did not differ from those in pain-free controls. Statistical methods were consistent, with both frequentist and Bayesian approaches leading to the same conclusions. Our study fails to replicate the finding that peripheral BDNF is altered in fibromyalgia, and instead our findings suggest that plasma levels of growth factor appear normative in fibromyalgia.

Objective Irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD) have similar symptoms and are affected by psychological factors via gut-brain-interactions. However, previous studies on IBS and IBD showed inconsistent results regarding psychological factors, potentially because they failed to consider the impact of symptom activity. The aim of this study was 1) to compare psychological distress and psychological risk factors among patients with IBS, IBD and healthy controls (HC), and 2) to assess the impact of symptom activity. Methods A controlled cross-sectional study was conducted. Patients with IBS and IBD were recruited in several primary, secondary, and tertiary medical care units between 02 and 12/2017 in Germany. Overall, 381 matched participants (127/group, 63% female) were included. For the second analyses, patients with IBD were distinguished in patients with active (n = 93) and non-active (n = 34) symptoms. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, attachment style, and mentalizing capacity) were measured. Results Patients with IBS showed higher psychological distress and more psychological risk factors than patients with IBD and HC. However, patients with IBD and active symptoms showed similar psychological distress than patients with IBS, except for lower illness anxiety (p Conclusion With the exception of higher illness anxiety in IBS patients, differences in psychological factors between patients with IBS and IBD were more strongly associated with symptom activity than with the underlying diagnosis. Therefore, this study challenges previous concepts of distinguishing functional and organic gastrointestinal diseases, but highlights the role of symptom activity and illness anxiety. Trial registration DRKS00011685.

The aims of this study are to assess patients’ preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients’ preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients’ 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p

To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret.Patients with breast or colon cancer (n=71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2.After controlling for clinician clusters, higher PE was directly associated with more SDM (β=0.43, p0.01) and lower decision regret (β=-0.28, p0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (β=-0.33, p0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (β=0.03, p=0.74).PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions.Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged.

Background Oncological patients often feel left out of important treatment decisions. However, when physicians engage them in shared decision-making (SDM), patients benefit in many ways and the situation is improved. SDM can effectively be taught to physicians, but participation barriers for SDM physician group trainings are high, making it hard to convince physicians to participate. With this in mind, we aim to develop and evaluate two new dissemination strategies for a brief, SDM training program based upon a proven SDM group-training concept: an individualized context-based SDM face-to-face training (IG I) and a web-based interactive SDM online training (IG II). We aim to analyze which improvements can be achieved by IG I and II compared to a control group (CG) in physician SDM competence and performance as well as the impact on the physician-patient relationship. Furthermore, we analyze differences in satisfaction concerning the two dissemination strategies by means of a training evaluation. Methods/design We examine – based on a three-armed randomized controlled trial (IG I, IG II, CG) – the effectiveness of two new dissemination strategies for a SDM training program compared to a CG receiving no SDM training (voluntary access to SDM training as an incentive for participation after completion of the study). We aim to include 162 physicians randomized to one of the three arms. There will be two assessment points in time (before intervention: T0 and post-training: T1). The main outcome is the SDM competence of physicians as measured by an established observational assessment rating system (OPTION-12) by means of consultations with Standardized Patients. Standardized Patients are individuals trained to act as “real” patients. Secondary outcome measures are the SDM performance (SDM-Q-9) and the Questionnaire on the Quality of Physician-Patient-Interaction (QQPPI) both rated by Standardized Patients as well as the physicians’ training evaluation. Discussion This trial will assess the effectiveness and acceptability of two new dissemination strategies for a brief, SDM training program for physicians. Opportunities and challenges regarding implementation in daily routines will be discussed. Trial registration ClinicalTrials.gov, Identifier: NCT02674360. Prospectively registered on 4 February 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-3112-7) contains supplementary material, which is available to authorized users.

Aims With the introduction of widespread pain (WSP) as a separate diagnostic code in the ICD-11, WSP has now become an own clinical diagnosis independent of the underlying pathophysiology. Research has reported aetiological associations of WSP and cardiovascular diseases. However, studies on mortality risk in individuals with WSP have reported inconsistent results. This study investigates whether there is increased mortality in WSP individuals and establish potential determinants of mortality risk. Therefore, we evaluates the population-based prospective cohort of the Framingham Heart Study (FHS). Methods and results The FHS is a longitudinal multi-generational study. Pain status was assessed uniquely between 1990 and 1994. Cox proportional hazards modelling was used to estimate hazard ratios (HRs) of WSP on all-cause mortality controlling for sex and age, cardiovascular risk factors, cancer history, lifestyle factors and current medication. WSP examination was carried out in 4746 participants of the FHS (60.3 ± 13.5 years, 55.1% women). A total of 678 (14.5%) subjects fulfilled the criteria for WSP, whereas 4011 (85.5%) subjects did not. The follow-up time was 15 years, during which 202 persons died in the WSP group and 1144 in the no-WSP group. When adjusting for age and sex, all-cause mortality was increased by about 16% in WSP subjects. Individuals with WSP had an increased HR particularly for cardiovascular cause of death (HR adjusted by age and sex = 1.46, 95% confidence interval 1.10–1.94). Conclusion Our data show that in a large population-based cohort, WSP is associated with increased HR for cardiovascular cause of death, underlining the need for pain assessments in cardiovascular practice.

Objectives The aim of this study was to examine visual function and eye symptoms in fibromyalgia patients, with a particular focus on dry eye syndrome and eye pain. Methods A tertiary care center-based cross-sectional study was carried out in chronic musculoskeletal pain patients diagnosed with fibromyalgia. Chronic musculoskeletal pain patients without fibromyalgia were enrolled as a comparison group. Self-reported eye pain was investigated with the McGill pain questionnaire and the numeric rating scale. In addition, we assessed corrected visual acuity, vision-related quality of life, and self-reported dry eye syndrome. Results A total of 90 musculoskeletal pain patients were included, with 66 patients fulfilling American College of Rheumatology 1990 criteria for fibromyalgia. Sixty-seven percent (95% confidence interval [CI] = 56%-78%) of the fibromyalgia patients reported eye pain, and 62% (95% CI = 43%-81%) of those were without fibromyalgia diagnosis. Sixty-seven percent (95% CI = 56%-78%) of the fibromyalgia patients reported an experience of dry eye compared with 76% (95% CI = 57%-95%) in the nonfibromyalgia group. Vision-related quality of life was noticeably reduced in both groups. Conclusions Eye pain and dry eye are common in chronic pain patients, with comparable prevalence in musculoskeletal pain patients with and without fibromyalgia.

Psychological trauma is associated with an increased risk for chronification of nonspecific chronic back pain (nsCLBP) independent of posttraumatic stress disorder (PTSD). However, the mechanisms underlying the role of psychological trauma in nsCLBP are less clear than in PTSD. Therefore, this study considered whether psychological trauma exposure (TE) is accompanied by specific alterations in pain perception. The study included 56 participants with nsCLBP and TE (nsCLBP-TE), 93 participants with nsCLBP without TE (nsCLBP-W-TE), and 31 pain-free controls. All participants underwent a thorough clinical evaluation. The standardized quantitative sensory testing protocol of the "German Research Network on Neuropathic Pain" was used to obtain comprehensive profiles on somatosensory functions in painful (back) and non-painful areas (hand). The protocol consisted of thermal and mechanical detection as well as pain thresholds, vibration thresholds, and pain sensitivity to sharp and blunt mechanical stimuli. Psychological trauma was validated by structured clinical interview. Trauma-associated symptom severity, anxiety, and depressive symptomatology were assessed by self-report questionnaires. Differences in somatosensory function were seen only for pressure pain thresholds. Compared with controls, nsCLBP-TE revealed hyperalgesia generalized in space with lower thresholds in painful and non-painful areas, whereas nsCLBP-W-TE demonstrated localized alterations with decreased thresholds only in the pain-affected area of the back (P ≤ 0.006). Our findings suggest an augmented central pain processing in nsCLBP-TE (alterations in painful and non-painful areas), whereas nsCLBP-W-TE show only local changes (alterations only in the painful area) suggesting regional sensitization processes. This finding might explain why TE without PTSD is associated with an increased prevalence of chronic pain.

The main focus of the paper is on the description of the development and current state of research and implementation of patient-centered care (PCC) and shared decision making (SDM) after fifteen years of substantial advances in health policy and health services research. What is the current state of SDM in health policy? The "Patients' Rights Act" from 2013 standardizes all rights and responsibilities within the framework of medical treatment for German citizens and legal residents. This comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on a clinician-patient-partnership. What is the current state of SDM interventions and patient decision support tools? SDM training programs for healthcare professionals have been developed. Their implementation in medical schools has been successful. Several decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care, specifically for national cancer screening programs. What is the current state of research and routine implementation? The German government and other public institutions are constantly funding research programs in which patient-centered care and shared decision-making are important topics. The development and implementation of decision tools for patients and professionals as well as the implementation of CME trainings for healthcare professionals require future efforts. What does the future look like? With the support of health policy and scientific evidence, transfer of PCC and SDM to practice is regarded as meaningful. Research can help to assess barriers, facilitators, and needs, and subsequently to develop and evaluate corresponding strategies to successfully implement PCC and SDM in routine care, which remains challenging.

Fruhe Missbrauchserlebnisse (FME) in der Kindheit und Jugend werden als Risikofaktor fur die Entstehung und Ausbreitung chronischer Schmerzen diskutiert. Ob spezifische Zusammenhange zwischen FME und unterschiedlichen Schmerzdimensionen bei chronischen nichtspezifischen Kreuzschmerzen [“chronic low back pain“ (CLBP)] bestehen und ob psychische Symptome diese vermitteln, ist nicht bekannt. Mittels Schmerzzeichnung, multidimensionalem Schmerzfragebogen und Schmerzempfindungsskala wurden 103 Personen mit klinisch validiertem CLBP untersucht. Mit dem Childhood Trauma Questionnaire wurden retrospektiv physische, sexuelle und emotionale FME im Kindes- und Jugendalter erfragt. Als mogliche Mediatoren wurden angstliche, depressive und dissoziative Symptome erfasst. CLBP-Personen mit FME geben im Vergleich zu CLBP-Personen ohne FME hohere Schmerzintensitaten, eine grosere Schmerzausbreitung, hohere affektive und sensorische Schmerzempfindungen sowie eine starkere Beeintrachtigung durch den Schmerz an. In multivariaten Analysen zeigt sich nur ein direkter Zusammenhang von FME mit der Schmerzausbreitung. Ein indirekter – uber dissoziative und angstliche Symptome vermittelter – Zusammenhang besteht zur sensorischen Schmerzempfindung. Der Einfluss von FME auf CLBP unterscheidet sich zwischen den Schmerzdimensionen, sodass eine differenzierte Betrachtung erforderlich ist. FME scheinen ein Risikofaktor fur die raumliche Ausbreitung von Schmerzen bei CLBP-Personen zu sein. Spezifische diagnostische und ggf. therapeutische Angebote bei CLBP mit zusatzlichen Schmerzarealen scheinen indiziert.

Objective To determine the prevalence of chronic back pain in the general population and to establish an evidence-based subclassification system for chronic back pain based on pain extent. Design Representative population-based survey. Setting South-western Germany. Subjects Four-thousand representative residents were contacted. The corrected response rate was 61.8% (N = 2,408). Those suffering from chronic back pain (pain ≥45 days/last 3 months) were invited to a clinical evaluation. Outcome Measures Chronic back pain, spatial extent of pain, sociodemographic and clinical variables. Results Age- and sex-adjusted prevalence rate for chronic back pain was 17.7%. Analyzing pain extent, we found that only 19.6% suffered strictly from chronic local back pain, while the majority indicated additional pain regions. Thus, we developed a subclassification system based on pain extent that consists of four more homogeneous groups (19.6% strict chronic local pain, 42.1% chronic regional pain, 24.3% common chronic widespread pain, 13.9% extreme chronic widespread pain). Interestingly, in this system, increasing pain extent was significantly associated with higher distress, as reflected by sociodemographic (e.g., lower education, lower social class, and higher application rate for disability pension) and clinical variables (e.g., higher pain intensity, more pain medication, more consultations, higher impairment, and lower quality of life). Conclusions Chronic back pain is prevalent and usually involves additional pain areas outside of the back. This challenges the concept of chronic back pain as a distinct entity. To identify patients who are distressed by chronic back pain, a four-class taxonomy based on pain drawings is both feasible and clinically useful.

Objective This study systematically reviewed the evidence regarding the effects of eye movement desensitization and reprocessing (EMDR) therapy for treating chronic pain. Design Systematic review. Methods We screened MEDLINE, EMBASE, the Cochrane Library, CINHAL Plus, Web of Science, PsycINFO, PSYNDEX, the Francine Shapiro Library, and citations of original studies and reviews. All studies using EMDR for treating chronic pain were eligible for inclusion in the present study. The main outcomes were pain intensity, disability, and negative mood (depression and anxiety). The effects were described as standardized mean differences. Results Two controlled trials with a total of 80 subjects and 10 observational studies with 116 subjects met the inclusion criteria. All of these studies assessed pain intensity. In addition, five studies measured disability, eight studies depression, and five studies anxiety. Controlled trials demonstrated significant improvements in pain intensity with high effect sizes (Hedges' g: −6.87 [95% confidence interval (CI95): −8.51, −5.23] and −1.12 [CI95: −1.82, −0.42]). The pretreatment/posttreatment effect size calculations of the observational studies revealed that the effect sizes varied considerably, ranging from Hedges' g values of −0.24 (CI95: −0.88, 0.40) to −5.86 (CI95: −10.12, −1.60) for reductions in pain intensity, −0.34 (CI95: −1.27, 0.59) to −3.69 (CI95: −24.66, 17.28) for improvements in disability, −0.57 (CI95: −1.47, 0.32) to −1.47 (CI95: −3.18, 0.25) for improvements in depressive symptoms, and −0.59 (CI95: −1.05, 0.13) to −1.10 (CI95: −2.68, 0.48) for anxiety. Follow-up assessments showed maintained improvements. No adverse events were reported. Conclusions Although the results of our study suggest that EMDR may be a safe and promising treatment option in chronic pain conditions, the small number of high-quality studies leads to insufficient evidence for definite treatment recommendations.

There is evidence for long-term alterations in pain tolerance among athletes compared with normally active controls. However, scientific data on pain thresholds in this population are inconsistent, and the underlying mechanisms for the differences remain unclear. Therefore, we assessed differences and similarities in pain perception and conditioned pain modulation (CPM) at rest in endurance athletes and normally active controls. The standardised quantitative sensory testing protocol (QST) of the ‘German-Research-Network-on-Neuropathic-Pain’ was used to obtain comprehensive profiles on somatosensory functions. The protocol consisted of thermal and mechanical detection as well as pain thresholds, vibration thresholds, and pain sensitivity to sharp and blunt mechanical stimuli. CPM (the diffuse-noxious-inhibitory-control-like effect) was measured using 2 tonic heat pain test stimuli (at the temperature exceeding a subjective pain rating of 50/100) separated by a 2-min cold-pressor task (CPM-TASK; conditioning stimulus). Pain ratings were measured with a numerical rating scale. Endurance capacity was validated by assessment of maximum oxygen uptake (VO2max). Participants included 25 pain-free male endurance athletes (VO2max > 60 mL/min ∗ kg) and 26 pain-free normally active controls (VO2max Athletes were significantly less sensitive to mechanical pain but showed higher sensitivity to vibration (P Our data show that somatosensory processing in athletes differs in comparison with controls, and suggest that the endogenous pain inhibitory system may be less responsive. This finding may explain the paradoxical propensity of athletes to develop chronic widespread pain.

Zusammenfassung Fragestellung: Die Klassifikation und Therapie von Patienten mit chronischen Schmerzen in mehreren Korperregionen ohne hinreichend erklarenden somatischen Krankheitsfaktor ist umstritten. Das diagnostische Etikett "Fibromyalgiesyndrom" (FMS) wird von einigen Vertretern psychosozialer Facher und der Allgemeinmedizin abgelehnt. Methode: Zusammenfassung der wichtigsten Empfehlungen der aktuellen S3-Leitlinien zum FMS und zu nicht-spezifischen/funktionellen/somatoformen Korperbeschwerden. Ergebnisse: Das FMS ist eine funktionelle Storung, bei der psychosoziale Faktoren in Entstehung und Verlauf bei derMehrheit der Patienten eine wesentliche Rolle spielen. Die Diagnose eines FMS kann anhand des typischen Beschwerdebildes und durch Ausschluss somatischer Differenzialdiagnosen ohne Tender Point Untersuchung anhand der 2010 modifizierten diagnostischen Kriterien des American College of Rheumatology gestellt werden. Aus psychosomatischer Sicht sollte eine Einordnung nach Schweregrad vorgenommen wer...

Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P < 0.001) indicating induction of CPM. Conditioned pain modulation in CLP was significantly higher than that in CWP and FMS (P < 0.001), but CPM in CWP and FMS did not differ. Interestingly, a higher number of painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values