VL 1 Zusammenfassung - Psychosomatik PDF

VL9 Modell der Definition !...

VL9 Modell der Definition ! * Bio-psycho-soziales in Zusammenfassung Locker I) Schmerz ist adaptiv, hat einen evolutionären Sinn. Gibt Warnsignal : (Verletzung zeigt sich im verzerrten Gesicht, Menschen kommen um dir zu helfen) II) Schmerz kann chronisch werden „chronifiziert“ und ist dann maladaptiv. Körper lernt den Schmerz und hört nicht mehr auf ¨ III) Schmerz ist immer real, obwohl es auch keine organische Ursache dafür geben kann. Es braucht neue Wege, die gegen Schmerze helfen - wie in Bewegung gehen, was uns als kontra-intuitiv erscheint. Vermeidung ist das schlechteste. ~ Video tamethebeast ; system have to von nervous is learning pain. We way attitude/lifestyle change approach it in a new , viel mega nachvollziehbar alle haben Rückenschmerzen - ↑ F Lebenszeit bisschen kan wär gewesen S & Krass , aber macht auch Frauen Männer Sinn , alle haben Bauchschmerzen  schwierig für Chronisch-Kranke ; meist vergeben hier wird es oft nur Opioide ↳ (chronisch) Rolle der t (FingsteDepressions Fragebe eine & konkrete (Psychosomatik ~ -z B. ändern. weiter mit Friends treffen ! (schwierig blisteine (nur bei Sie haben ein Körper-Stress-Problem , real noch im Alert sehr langsamer Prozess T-Veränderungen braucht Monate ↓ Estressreaktion Z B.. Antilope bewegt sich nicht mehr T freeze" T muss wieder s ; adaptiv ! bei Psychosomatik bleibt oben , nicht mehr zu Fight-flight Homoostase ; kann keine Energie mehr tanken Choch zu bewältigen flight 6 B. ) Homoostase/tmehanan. , kommt nicht mehr auf Aktiviert , alert Kass sehr Wichtig , es wieder nach unten geht hier Kommunikation ist möglich ↑ => Gleichgewicht entspannt , · Entspannung Bewegung , , Schlaf Cust-come-down Therapie ; Dinge tun  nicht mehr Psychosomatik hier ; System funktioniert Clässt sich nicht so schnell fixen weil bei Psychosomatik spielt beides eine Rolle Gesellschaft > Psychosomatische Probleme Mensch als Ganzes wird wichtig (im Gegensatz zu organisch) ↳ grosse spasbrestpaumbreite Software * t. B. Kniespezialist in , falscher operieren Ausax  * -- stärkeres Gefühl der Stigmatisierung weil , Arthritis hat eine diffus mehr Diagnose + Ursache , also weniger Stigma ↑ Je nachdem welche Diagnose kommt es zu erhöhter Stigmatisierung genauerer Blick : funktionell ist nicht immer mehr stigmatisiert ! im aber curonique fatigue sehr stigmatisiert ↓ multiple & Sklerose Wegen Kapitalismus Cz B.. Long Covid) fruktionelle Erkrankung , schwer zu vermitteln & nicht gut erforscht  CPP = Prüfungsliteratur ICD - M (Lebensart) temotionale & funktionelle Beeinträchtigung > es - geht primär um den Schmerz Psychosomatik · primär : Psychosomatik , Schmerz als primär Ursache Folge · Sekundär : organische , Schmerz als von Organisch & Psychosomatik 12 Umstrittener Begriff) neue Terminologie im ICD-M , rückt Schmerz in Vordergrund - Psychosomatik zeigt ähnliche Muster ↑ Komorbidität Entspannen · Schlaf , Bewegung , · viel körperzentrierte Behandlungen · rein kognitiv macht nicht viel sinn Shörperlich unbewusst bewusst wahrnehmen  8 2 -sehr tief bei den Ki-J : nur 40 % erfüllen genug Bewegung eine ~ nachher gehtsnicht ession Die WHO empfiehlt Anzahl Stunden hat auf das Vorkommen Depression grosse Auswirkungen ; von Aktiv 2h gehen statt Th macht sehr Unterschied ; bis roten Linie gibt Unterschiede zu nur grossen zur es grüsse Einfluss Signifikant negativer mehr Distress ↑ (Büro ~ Skein Einfluss auch wenn streng körperlicherewegungreizeitung wollin ich gehe -Viel ! zeigt wieder : emotional bei Leisure grosse wichtig : Veränderung wo bewege ich mich mit Spass ?  S · Antidepressiva & Joggen den gleichen Effekt über 16 Wochen * aber ; Joggen zu gehen ist schwieriger zu überzeugen ; die Personen konnten auswählen , also nicht ganz randomisiert Lifestyle verändern Defining chronic pain in epidemiological studies: a systematic review and meta-analysis "Epidemiologische Studien zu chronischen Schmerzen" beziehen sich auf Forschungsarbeiten, die sich mit der Verbreitung, den Ursachen und den Risikofaktoren von chronischen Schmerzen in der Bevölkerung befassen Abstract:  Document the operational definitions applied in epidemiological studies of chronic pain  Examine whether pain definitions and other methodological factors are systematically related to prevalence estimates  Original research reports searched: chronic pain criteria were highly inconsistent! Prevalence rate ranged from 8.7 - 64.4% - huge heterogeneity in forest plots  prevalence estimates were significantly related to survey method - but counted small for Between- studies variation - > wie wir eserheben macht Unterschied enormen  interaction effect of survey method by sex, questionnaire and interview (other covariates not significantly related to the prevalence estimates)  Be aware: interview survey method may give lower chronic pain reporting than questionnaire and effect stronger in men Introduction  chronic pain as a distinct disease entity and a global burden: needs a plausible operational definition of the phenomenon and adequate monitoring tools  No common standard exists, estimates (incidence, prevalence, impact) vary widely countries and across studies within same country…! —> Standardized and widley accepted epidemiological methods for identifying individuals with chronic pain is from immense value  most likely: large disparities because of methodological factors and varying definitions of chronic pain  IASP defined chronic pain as pain that lasts beyond the normal healing time… what is normal? Conditions, age, comorbities,... —> some chronic have pathology which rarely heals.. illogical! Normal healing time cannot be determined —> IASP pragmatic definition: chronic pain lasting for 3 months or more in the absence of other criteria… but also limited consensus  variety of additional criteria (assessment windows, pain frequency, taxonomy, intensity, severity, impact…) gives challenge to comparability of studies and the interpretation. merken ! - ICD-11: classify pain disorders into 7 subgroups (IASP Task force) —> pain experts using pain etiology, underlying pathophysiological mechanisms, body site —> expert group defines chronic pain: persistent or recurrent pain lasting longer than 3 month, for each of the underlying diagnoses they add optional specifiers (psychosocial factors and pain severity – like intensity, funcional impairment) We believe there are good reasons to estimate the prevalence of chronic pain per se across diagnoses 1. twin studie suggest comorbidity between pain conditions large extent due to common genetic etiology 2. Major associated comorbidities and outcomes (fatigue, anxiety, depression) largely similar for different they so types of chronic pain —> may depend more on severity of pain (than diagnoses) * 3. social challenges and challenges are related to comorbidity of several pain conditions 4. pharamlogical and psychological treatment methods are applied across wide range of diagnoses 5. term chronic pain is widely used, not referring to specific pain sites Consensus (ICD, order) only valuable if based on sound empirical evidence improve in epidemiological field AIM: document the practice of different operational definitions of chronic pain prevalence in the epidemiological literature and to examine whether the pain definitions and other methodological factors are systematically related to prevalence estimates. Istudy design Method:   searched databases for „chronic pain, prevalence and epidemiolog“  Only included study samples with at least 1000 individuals and excluded studies limited to specific pain conditions (fibromyalgia…) and excluded covering fewer than 5 of 15 selected body regions (because with at least 5 more likely general chronic pain)  Because the aim of the current review was to document the defini ons of chronic pain and to analyse how these defini ons were related to prevalence es mates, Meta-analyses:  outcome variable: Prevalence  Covariate such as geography, sampling year, survey method, sampling frame, paricipation rate, percentage of women, pain duration and location  Forest plots to visually assess the relation between female-male ration and other covariate  most of studies from High-income countries - western europe studies included. What else Despite these exclusions, the prevalence estimates did not show any consistent pattern of being higher or lower Results depending on who was excluded.  no obvious relationship between exclusion criteria and prevalence estimates. This suggests that the exclusion criteria might not play a significant role in determining how common chronic pain appears in the population studied, at least in the studies Definitions of chronic pain analyzed.  phrasing, content and combinations of the 5 chronic pain criteria (pain duration, assessment, frequency, intensity, taxonomy) were largely inconsistent. Most common criteria used was duration of pain of < 3 months or >- 3. (68%, 18% with more than 6 monts)  apart from the criterion of 3-month duration and the wording “pain,” almost no agreement was found across studies in the definition of chronic pain  Huge variation in the overall prevalence rates —> from 9% - 65% —> forest plots with covariates could not show clear pattern  Lack of significant sex participation effects on the prevalence estimates  Does not show any clear pattern of regional differences Discussion  review showed huge inconsistency in the definition of chronic pain in the epidemiological literature —> comparing of prevalence estimates of questionable value… 9-65%  interview survey give lower estimates than questionnaires and effect seems to be larger for men than for women (small fration) —> problem of inconsistency in the definiton of chronic pain is under discussion nut despite of it still not any improvement. —> cutoff on 3-month-duration between acute vs. chronic lain, little agreement on anything else. —> hardly 2 research groups that assess chronic pain in the same manner. Not surprising the estimates vary widely even in same population!  tempting: variation in prevalence estimates is largely a direct result of inconsistencies of definition  Current results: indicate that using an interview method gives lower prevalence estimate than questionnaire (anonymity..)  Interaction effect of sex on the association between survey method and reporting chronic pain —> speculate  We did not find that geography, sampling year, sampling frame, par cipa on rate, percentage women, pain dura on, or pain loca on (musculoskeletal vs general pain) influenced the prevalence es mates. However, it should be kept in mind that other methodological factors which we did not inves gate might be of importance  interes ng to note that differences in the dura on criterion for chronic pain, which has been the subject to the most intense debate, appear to have li le or no effect on prevalence es mates, presumably because few people report pain that has lasted 3 to 6 months.  A large varia on in prevalence es mates is not only found between studies but also within studies, Because of the vast dispari es in the chronic pain defini ons, we were regre ably not able to find pa erns that would give us a valid answer to our ques on about the effect of the defini on on the prevalence es mates. Nevertheless, the analyses show that a er controlling for many of the poten al methodological factors, the studies remain highly heterogeneous. Implications  Chronic pain is a highly prevalent complaint with considerable individual and societal impact of ill health worldwide.  Classification in ICD-11 provide better tools, will depend on agreement and implementation. Facilitate comparability and maybe optional specifiers. Lack of golden standard makes estimates (incidence, prevalence, cost and comparison) comparison uncertain  Most of the studies focused on chronic pain in adults, a few also included older adolescents, whereas children and younger adolescents were rarely included. This gap needs to be filled. —> The lack of consistent chronic pain defini on makes it more difficult to monitor the incidence and prevalence, and therefore to evaluate and compare popula on interven ons. Conclusions The review showed huge inconsistency in the defini on of chronic pain in the epidemiological literature and small effects of the inves gated covariates on the prevalence es mates. The in- consistency in opera onal defini ons may undermine case for chronic pain being considered an important health issue. Researchers and clinicians should be aware of the probability that interview assessment will yield lower prevalence values than ques onnaires and that this difference may be larger in men than women. Prevalence from 9 to 65 %  The IASP classification of chronic pain for ICD-11: chronic primary pain Abstract article proposal for the new diagnoses of chronic primary pain (CPP) in ICD-11 Chronic primary pain is chosen pain has persisted for more than 3 month Associated with significant emotional distress and/or functional diability Pain is not better accounted for by any other condition Pain in this article: a biopsychosocial framework for understanding CPP. important —> all subtypes of the diagnosis are considered to be multifactorial in nature (biological, psychological and social factory contributing) Unlike the perspectives found in DSM-5 and ICD-10, the diagnosis of CPP is considered to be appropriate independently of identified biological or psychological contributors, unless another diagnosis would better account for the presenting symptoms. —> Such other diagnoses are called “chronic secondary pain” where pain may at least initially be conceived as a symptom secondary to an underlying disease goal: create a classification that is useful in primary care and pain management settings (development of individulized management plans) Assist both clinicians and researchers by providing a more accurate description of each diagnostic category Background on chronic primary pain DSM (APA) and ICD (WHO) used internationally for chronic pain BUT: found wanting in their accounts for chronic pain conditions —> no reflection of pain research over last two decades and no clear treatment and management implications —> ICD-10 when pain with absence of clear etiology (pathophysiological) than only option „somatoform pain disorder“… but when pathophysiological factors are also contributing to the pain problem… !? if accepted that chronic pain is a disease or a long-term condition, “then the philosophy of care may change from a biomedical model that views chronic pain as a symptom to that of a biopsychosocial one that views chronic pain as a disease or long-term condition” a definition ICD-10 german adaption: introduced chronic pain disorder with somatic and psych. factors —> but rests in psychiatric with no subtypes —> suggested concept of CPP in this article: clear definition and allowing for subtypes. classify chronic pain: acknowledge the likelihood of multiple interacting contributors to a chronic pain presentation by psychological factor cause s , —> NOT either somatic or psychogenic. j —> new diagnostic entity of CPP will provide framework to focus on conditions commonalities and differences (unite conditions) Need for classification New diagnosis independently of identified biological or psychological contributors (unless another diagnosis would better account). like lack of —> useful in both primary care and specialized pain management settings negative something , a --> classification should be in positive terms – observable concepts (not like it was previous, obscure...) IASP task force ICD initiative, WHO —> systematic and improved classification of chronic pain, exclusively to chronic pain syndromes (not disease-oriented, not acute pain) chronic pain defined: lasts or recurs for longer than 3 months (clear operationalization) and code for severity: records the intensity, emotional distress, inference in daily activities due to pain) —> specification on the severity: 3 dimensions, rating scales. Classification of CPP Chronic primary pain is defined as pain in one or more anatomical regions that (1) persists or recurs for longer than 3 months (2) is associated with significant emotional distress (eg, anxiety, anger, frustration, or depressed mood) and/or significant functional disability (interference in activities of daily life and participation in social roles - difficulties working, sleeping,…), (3) and the symptoms are not better accounted for by another diagnosis —> aims to avoid dichotomy of physical vs psychological. And it has to be ascertained if another diagnosis accounts better for the pain (Secondary pain syndromes) Frozen version of ICD-11. CPP with code MG30.0 —> when subtype unclear - CPP unspecified Classification of CPP (1, 2 , 3) are shared —> in addition to the common features, the individual types of CPP have unique characteristics Distinguis one particular diagnosis from another Fly from the definition are all shared here & I i F p 7 Discussion: CPP new diagnosis in the ICD-11 classification for chronic pain: embrace a number of poorly understood conditions (& avoiding obscure) health conditions in their own right. (Chronic secondary pain syndromes - pain a symptom of some underlying disease). chronic pain necessarily includes psychological, social dimensions in addition to biological components ICD-11 CPP can be combined with optional specifiers (distinguish level of severity for example - different codes for this) from theory to practise The new classification of CPP will have to be shown to be reliable and clinically useful! > - —> next step field trails to establish the psychometric properties of these codes and their utility —> more descriptive categories, expected that future evaluations will confirm higher retest reliability and inter- rater reliability Proposal: All chronic pain diagnoses should be presented in ICD-11 as a coherent category of diagnoses and not be divided up artificially as is the case in ICD-10. —> This confers a number of advantages, including when the categories are used for the worldwide collection of data for health statistics. For these statistics, different levels of granularity can be chosen. Chronic pain may be divided into primary vs 6 subtypes: of secondary pain syndromes or any of these top-level chronic pain diagnoses —> represents chronic pain in health statistics, which influence health policies and allocation of resources for prevention, treatment and rehabilitation as well as research! The new ICD-11 CPP classification expected to enhance pain management outcomes, - inferences about unknown aspects of an individual —> given a pain (sub)category, clinicians and researchers can infer likely causes of symptoms, predict most likely consequences, estimate a timeline, the most likely future developments, and optimize treatment plans for that person. —> identification of physiological, psychological, and social contributors to pain is specifically encouraged —> multimodal interventions that can address these factors and potentially enhance treatment outcomes. The German experience with the national variant code F45.41 (chronic pain with somatic and psychological factors) suggests that few large chronic pain diagnoses are more useful to guide treatment and its funding Multimodal pain management is regarded as the most helpful treatment form for chronic pain - applies to both primary and secondary pain syndromes (more helpful grouping of the diagnoses) —> should be recognized that any categorization may introduce an assimilation bias. ICD-11 users should be aware of this potential bias to limit its impact. Summary and conclusion: By including a distinct CPP syndrome classification within the ICD-11, it is hoped to avoid the problems associated with previous classifications of chronic pain when the etiology is unclear, but the emotional distress and functional disability associated with such pain are very evident. The availability of 6 classes of chronic secondary pain syndromes in the same classification will facilitate the distinction of pain as a disease or long-term condition from pain as a symptom. This classification has clear treatment and management implications: a multimodal approach that addresses the contributing psychological, social, and biological contributors is expected to lead to better outcomes for patients with CPP diagnoses of at least moderate severity, relative to unimodal interventions alone. In chronic secondary pain syndromes, there will be additional disease-specific treatment options to be considered as well. In addition, the representation of CPP in health statistics is expected to advance public policy and research.