SIP 2017 - Key Statement
Dr. med. Michael Schenk – Pain Clinic Berlin, Germany
"To fight chronic pain effectively, a structured approach is indispensable to achieve these goals: Screening programs for early detection of patients at risk, a stepped approach to meet the patients’ demands in a multilevel care system with outpatient and inpatient multimodal integrative programs."
Dr. med. Michael Schenk
Head Pain Clinic Berlin, Consultant in Anesthesiology, Pain Medicine,
Palliative Care Medicine and Addiction Medicine
Pain Clinic Berlin (Schmerzklinik Berlin), Center for integrative Multimodal
Pain Medicine and Center for Neuromodulation
Chronic pain (CP) is a pressing issue in Europe. 17 % of the European population suffers from CP, of which 30% have strong pain and 10% of these need a hospitalization (Breivik 2006). The economic consequences are enormous: The indirect expenses (unfitness for work, early retirement) for CP were assessed at more than 29 billion Euros in Germany (Dietl 2011). In the German healthcare system 6-8% of the costs are caused by treatment of CP (Neumann 2002). Unfortunately there is a mistreatment with an overuse of invasive procedures and operations and a lack of problem-adequate appropriate measures like MultiModal Pain Therapy (MMPT). For the treatment of chronic pain MMPT is considered as the gold standard (Guzmán 2002).
Besides a good quality, the intensity and length of treatment (e.g. between 14 and 21 days) must be adequate (Bendix, Härkäpää). Long-lasting effects on quality of life and restoration of working capability are only proven for interdisciplinary multimodal pain treatments (Chou 2007, Guzmán 2002, Van Tulder 2006, Williams 1996). Multimodal approaches have a clear advantage compared to unimodal approaches regarding return to work 81% vs 29% und 54% vs 20% (Hazard 1989, Flor 1992).
Fortunately, in Germany exists a structure for an adequate reimbursement of treatment expenses of intensive programs of MMPT in hospitals. The „pain-DRG´s“ (B47, I42, U42), are triggered by a pain-diagnosis (ICD-10) and a complex pain procedure (OPS 8-918). The costs for MMPT are covered by the health care providers.
But there exist still some unsolved issues: Specialized pain clinics are still not part of the German hospital plans. This resulted in an arbitrary historically caused non-symmetric distribution of pain clinics with many facilities in the south (e.g. Bavaria) and a big lack (e.g. Berlin).
Ambulant multimodal structures are not economically supported by the health care providers. Exceptions are some smaller „lighthouse-projects“, which do not reach the broader patients’ population.
Dr. med. Michael Schenk is consultant in Anesthesiology, Pain Medicine, Palliative Care Medicine and Addiction Medicine. He works as a clinician in the field of chronic pain. He began his career at the Charité University in Berlin and is now the head of the Berlin Pain Clinic. He is member of the executive board of the professional association of pain specialists in Germany (BVSD) and the 2nd speaker of the Special Interest Group (SIG) of Cancer Pain in Germany. He gives many national and international lectures and is honorary professor at the National Medical University in Kharkiv/Ukraine, where he helps to establish pain medicine.