Abstract
Pain therapy concepts should be based on a biopsychosocial model. A prerequisite for adequate pain therapy is the detailed medical history. The questions about the intensity of pain and especially about the quality of pain are crucial for the selection of drug therapy. In addition to the questioning, targeted physical examination is essential. This should be repeated in case of therapy-refractory pain in the course. The transfer of clinically relevant knowledge about the emergence and the development of pain occurs in the new cross-sectional area 14 “pain medicine” and has been anchored in the licensing regulations. Treatment-refractory pain, despite adequate pharmacological therapy, may be the result of individual metabolism. For tumor-related pain, opioid rotation is a suitable symptom control procedure. To avoid treatment-refractory pain peaks, the medication for the need for basic medication should be adjusted in the dose. Non-drug treatment should be targeted for treatment-refractory pain to promote patient’s ownership. Physiotherapeutic measures have the goal of increasing the self-efficacy of pain and regaining confidence in one’s own bodily functions.
Schmerz ist einer der häufigsten Gründe für Arztbesuche und oft wird er fachübergreifend behandelt. Meist kann der Behandler mithilfe einfacher Therapiealgorithmen in kurzer Zeit eine Linderung gewährleisten. Manchmal aber ist der empfundene Schmerz therapierefraktär, er eskaliert oder chronifiziert. Warum das so ist, erläutert dieser Beitrag. Zudem stellt er praxisorientierte Lösungswege vor – auch für den Umgang mit „schwierigen“ Patienten.
Schlüsselwörter
therapierefraktär - Chronifizierung - biopsychosoziales Schmerzmodell - Schmerzspitzen - Opioide
Key words
treatment-refractory - chronification - biopsychosocial pain model - pain points - opioids
