Content of inpatient pain therapy
Diagnosis
The focus of the inpatient stay lies in therapeutic rather than diagnostic measures, which should be completed before the start of the inpatient stay, if possible. Nevertheless, at the beginning of the stay the pain therapy doctors check the (mostly comprehensive) diagnostic test results that are present, and arrange any further medical investigations required to either exclude or include possible contributing organic factors to the chronic pain problem.
In addition, a comprehensive psychological diagnosis is carried out.
Therapy
Therapeutic interventions include, among other things:
- Comprehensive education on the vicious cycle of chronic pain
- Establishing age-appropriate and favorable ways of behavior to deal with chronic pain, for example, going to school in spite of existing pain
- Instruction in increased self-sufficiency in dealing with pain
- Verbal reinforcement of favorable ways of behavior
- Non-observance of pain-reinforcing interactions, for example, whining
- Instruction and support for parents in implementing specific behavioral therapy measures.
In one-on-one psychological discussions, we focus first of all on clarifying the goal (for example, “freedom from pain” or “being able to walk again”, with consideration for: What is realistic?) and education (for example, vicious cycle of pain). This is followed by training in pain coping strategies (for example, “54321-technique” or imagination of a “safe place”). If needed, patients can be supported in dealing with possible existing emotional problems, such as anxiety or depression.
Besides education, family discussions focus on answering the question of which coping behaviors have favorable or unfavorable effects on pain.
We also question whether the pain could be having a certain function within the family, for example, exemption from household chores and perpetuation of attention-giving patterns that maintain the pain.
Medically we focus, among other things, on clarification of sensible medicinal strategies, for example, with hard-to-treat migraines.
Scientific studies on pain therapy in children and adolescents
Our studies regarding inpatient pain therapy show that childhood and adolescent pain conditions are amenable to treatment (see Research). The results of our studies concur with the few other international studies on this topic. The successes of inpatient children’s pain therapy are maintained and significantly improve the lives of the children and adolescents who are treated.
These study results can be found in the following publications:
T Hechler, A Ruhe, P Schmidt, J Hirsch, J Wager, M Dobe, F Krummenauer, B Zernikow
Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: Randomized controlled trial of efficacy and economic effects
Pain 2014; 155(1): 118-28
M. Dobe, T. Hechler, J. Behlert, J. Kosfelder, B. Zernikow
[Pain therapy with children and adolescents severely disabled due to chronic pain - Long-term outcome after inpatient pain therapy]
Der Schmerz 2011; 4: 411-422 (Article in German)
T Hechler, A Martin, M Blankenburg, S Schroeder, J Kosfelder, L Hölscher, H Denecke, B Zernikow
Specialized multimodal outpatient treatment for children with chronic pain: Treatment pathways and long-term outcome
Eur J Pain 2011, 15(9): 976-984
T Hechler, M Blankenburg, M Dobe, J Kosfelder, B Hübner, B Zernikow
Effectiveness of a multimodal inpatient treatment for pediatric chronic pain: A comparison between children and adolescents
Eur J Pain 2010; 14(1):97.e1-97.e9
T Hechler, M Dobe, J Kosfelder, U Damschen, B Hübner, M Blankenburg, C Sauer, B Zernikow
Effectiveness of a 3-week multimodal inpatient pain treatment for adolescents suffering from chronic pain. Statistical and clinical significance
Clin J Pain 2009; 25(2): 156-166
M Dobe, U Damschen, B Reiffer-Wiesel, C Sauer, B Zernikow
[Multimodal inpatient pain treatment in children - Results of a three-week program]
Der Schmerz 2006;20:51-60 (Article in German)