Aufbau verhaltensmedizinischer Versorgungsstrukturen für chronische Schmerzpatienten

Abstract

Behavioural Medicine and Treatment of Chronic Pain – Building up a Multidisciplinary Concept Introduction: The effectiveness of multidisciplinary treatment of chronic pain with an emphasis on a cognitive behavioural approach is clearly shown by randomised controlled trials. However, it is difficult to motivate patients with chronic pain for this type of treatment. We compared the effectiveness of a consultation model and a liaison model of co-operation between an outpatient pain clinic and a psychosomatic department in creating motivation for psychotherapy. Patients and Methods: In a retrospective design we collected data of all patients seen in the pain clinic during 6 months before (N = 165) and 6 months after (N = 277) changing from a consultation to a liaison model. Clinical data were documented by the Multiaxial Pain Classification (MPC). Level of depression was assessed by Depression-Scale (DS), somatic complaints by list of complaints (BL). Results: In the liaison model diagnostic sessions with the consulting psychotherapist were significantly more often recommended by physicians in the pain clinic (25.6% vs. 13.9%) and accepted by patients (63.3% vs. 30.4%) compared to the consultation model. In either system 80% of the patients accepted the recommended psychotherapy. After changing to the liaison type of co-operation, there was a significant decrease in prescription of opioid and benzodiazepine drugs. Conclusion: The liaison model of co-operation was significantly more effective in enhancing physician’s and patient’s motivation for a psychosomatic approach in the management of chronic pain. Psychotherapy is better accepted by patients suffering from chronic pain if it is offered in a multidisciplinary context and in the familiar surroundings of the pain clinic.