| dc.description.abstracteng | The goal of this study was to create a profile of pain consultation services (PCS) in a university hospital setting. In this particular study, pain consultation services consisted of an acute pain service (APS), a palliative care consultation service (PCCS) and a pain consultation service of the university hospitals pain clinic (PCPC). An individual performance profile was created for each PCS investigating inpatient pain consultation requests. 1391 contacts in 882 patients (PCPC), 950 contacts in 273 patients (PCCS) and 633 contacts in 128 patients (APS) were analyzed retrospectively.
The results have shown that a majority of patients needed an adjustment of their pre-existing pain-medication regimen. However, non-medicinal recommendations also played an important role in each PCS, varying in their focus. Approximately 50 % of PCPC consultations consisted of requests for diagnostic aid or specific (interventional) procedures, physical therapy, and psychological and psychiatric co-consultations.
At 17 % of patients, seen by the PCCS, suggestion for further diagnostics were made, however, the focus of non-medicinal recommendations was on psycho-social aspects, for example assistance in questions of further care-management and conversations concerning prognosis and general counseling of patients and their families.
The APS generally provided special interventional treatment methods such as epidural pain catheters, patient-controlled-intravenous analgesia and regional pain catheters.
The results of this study have shown that a “pain consult” in an university hospital setting delivers a great variety of treatment-recommendations and covers a broad range of pain diagnosis and fairly complex pain patients. Difficulties in categorizing these complex patients appear to play an important role in daily clinical practice. A mixture of acute, chronic and tumor-related pain was found in a respectable number of patients. Solely optimizing analgesic regimens do not often seem sufficient to treat these complex pain patients. Hence, providing adequate pain-management-strategies can create challenges for existing inpatient-care structures.
Based on the findings of this study, a multidisciplinary approach and multimodal diagnosis and new therapeutic concepts are needed to improve care for pain patients in any hospital setting. | de |