Pain is the most common cause of human health problems. Nevertheless, until just a few years ago, pain therapy was considered the stepchild of medicine. The upheavals and almost breathtaking innovative developments our generation is currently experiencing can be illustrated by the widespread widespread illnesses of migraines and headaches. In the history of headache therapy there are times in which the cooling of the uterus with honey, vaginal suppositories with cannabis extracts, skull trephination, alligators tied to the head, the cutting of pigtails, the repeated use of intestinal enemas, the administration of nitroglycerin or marijuana and various diets were considered state of the art. These “standards” lasted for thousands of years of human history. Until recently, pain therapy treatments were received depending on the therapist's individual level of experience. The first coordinated therapy recommendations from a specialist society for the treatment of migraines and headaches on a scientific basis were published by the German Migraine Society in 1986. An internationally valid headache classification was published for the first time in 1988. These two events set the starting point for coordinated diagnosis and treatment of migraines and headaches. There have been similar developments in recent years for back pain, tumor pain and neuropathic pain. However, scientific findings and newly developed therapeutic methods are in vain if it is not possible to make them available to those who suffer as directly as possible and to implement them in practice.

Networking, structuring and organization

The magazine Der Pain therefore devoted a focus to innovative forms of care in pain therapy in its April 2013 issue . Authors from the field of health services research, statutory health insurance companies and the pharmaceutical industry as well as network players from the field of innovative forms of care for tumor pain, headaches, back pain and neuropathic pain show future-oriented approaches in pain therapy from their respective perspectives using concrete examples. It becomes clear that obstacles to adequate care for the widespread disease pain do not result from a lack of scientific knowledge. The deficits identified by current health care research are largely based on organizational deficiencies in the care landscape. The lack of training and further education of doctors and therapists in pain therapy is the most significant obstacle to efficient pain therapy. Resource deficits, a lack of attention to the special concerns of specific clinical pictures, inadequate reimbursement by health insurance companies, organizational difficulties, a lack of provision of resources, incorrectly set priorities, a lack of coordination and integration, mismanagement, a lack of political awareness, a shortage of doctors and general organizational errors are the biggest stumbling blocks that stand in the way of efficient and modern pain therapy. Contemporary pain therapy requires a central awareness among health politicians, health insurance companies, experts, specialist societies and those affected in order to jointly address the lack of priority and the general organizational and coordination errors.

Open sectors, close marshalling stations

A central reason for the hindrance to effective pain therapy is the sectoral structure of the traditional treatment landscape. The traditional healthcare system in Germany was not based on scientific treatment requirements, but was politically negotiated through service providers and the healthcare administration. In this process, eleven sectors of the healthcare system were created, which are usually legally and budgetarily separated by sector. Those responsible for a particular sector limit their perspective to that area. The sustainability and efficiency of treatments are lost sight of. In addition, economical marshalling stations are created, the payment systems change several times during the treatment process and the incentive systems run counter to the quality of treatment. Until a few years ago, the organization, coordination, integration and financing of service provision were not the focus. But they are precisely the core components of an innovative design of the pain therapy care landscape.

Competition for better ideas

The focus of this issue begins with an analysis of the care situation for pain patients in Germany by M. Dietl and D. Korczak. The structural deficits in pain therapy are clearly demonstrated. According to this analysis, there is a lack of around 2,500 facilities in curative pain medicine, and there is also a significant undersupply in palliative medicine. In traditional structures, patients' access to multidisciplinary, cross-sectoral treatment is difficult; new networked concepts are urgent for contemporary pain therapy. The legislator created the organizational requirements for abolishing the sectoral separation of outpatient, inpatient and other service provision with the introduction of Section 140a ff. SGB V. Sectoral, isolated traditional structures are seen as the main cause of quality and efficiency deficiencies in pain therapy. It is therefore up to those involved in the healthcare system to actively and committedly use the contractual scope for design.

The struggle for a better idea, a more efficient conception and a more sensible implementation has also become an indispensable competitive parameter for health insurance companies, as J. Brunkhorst et al. from the perspective of the statutory health insurance company. By setting contribution rates across health insurance funds, health insurance companies have no direct opportunity to influence their income. Innovative offers that are not available in standard care represent a competitive advantage through increased quality, selection and service. The health insurance company's community of insured persons can also be relieved due to the better economic efficiency of innovative models and services beyond standard care are made possible for them .

S. Eble and T. Rampoldt point out in their contribution that innovative cross-sector treatment networks require a lot of creativity, design and organization. Economic behavior and success-oriented remuneration models of innovative contracts are still viewed with skepticism in traditional thinking because they affect the usual sectors and remuneration systems as well as power relations. Nevertheless, innovative forms of care cannot be stopped as a condition for a contemporary and future-oriented design of the care landscape. The alternative to organizing pain therapy through top-down political guidelines is the freedom of all actors to actively and creatively help shape the future healthcare system. Service providers in particular can and must become contractual partners on an equal footing who can demonstrate the coordination, organization, structure, quality, efficiency and cost-effectiveness of their services. The essential need for networking, coordination and integration of services is therefore evident for the future design of the healthcare system. Economical drug therapy is an integral part of this. It is therefore logical that drug manufacturers and manufacturers of medical devices can also become contractual partners in contracts in accordance with Section 140a ff. SGB V. Treatment networks contribute to increasing efficiency through specialization, improving interdisciplinary cooperation and sectoral interaction, and increasing patient satisfaction as a professional competitive advantage.

This special issue uses three practical examples to illustrate how such innovative, networked forms of care work in everyday life. The work of J. Osterbrink et al. analyzes pain management in people with tumor diseases from the perspective of individual network actors. The treatment network encompasses outpatient nursing, general practitioner and specialized outpatient palliative care in the city of Münster. The close communication exchange between the actors proves to be an essential service for efficient coordination and ensuring timely reactions. The results underline that networking, organization and coordination are essential prerequisites for securing and guaranteeing the highly complex treatment needs of people with tumor disease.

The work of H. Göbel et al. describes the background, conception and implementation of the nationwide headache treatment network. In this network, which spans the entire Federal Republic, an innovative national network of over 450 outpatient and inpatient pain therapists works together in a coordinated manner across sectors and disciplines. The groundbreaking treatment network for headache treatment shows that committed network partners can build a completely new care landscape for Germany and that the sustained high clinical and economic efficiency of specialized pain therapy can be demonstrated very successfully.

A. Schneider et al. describe a very innovative cross-sector pain medicine implementation in the Munich area. in her post. In a groundbreaking concept, multidisciplinary treatment teams in four different hospitals in the greater Munich and Lower Bavaria areas provide pain patients with multimodal care without therapeutic breaks. The focus is on therapy programs for patients with back pain, pain in old age, tumor pain and neuropathic pain.

A spirit of optimism and creativity

The overviews of the focus make it clear that the network actors involved live and process innovative forms of care with great commitment, a spirit of optimism and creativity. Networking, interaction and cross-disciplinary and cross-sector collaboration as essential components of a future-oriented healthcare landscape are of central importance in pain therapy. In recent years, significant progress has been made possible by these and other innovative pain therapy projects in Germany. The profound changes in healthcare are unstoppable. The new legal options open up creative treatment networks to help shape the care landscape in a cooperative manner. This results in a wide range of opportunities and development opportunities, especially for modern pain therapy, which are waiting to be exploited.

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Special issue of the magazine Der Pain