Around four million people in Germany suffer from chronic headaches. Treating them places high demands on even specialized pain therapists. In 2007, the Kiel Pain Clinic and the Techniker Krankenkasse (a German health insurance company) signed the first nationwide contract for integrated care of affected patients in practices throughout Germany.
In the interview, Prof. Göbel summarizes his experiences so far:
Professor Göbel, what is special about the new treatment concept?
Prof. Göbel: The new coordinated care concept represents a milestone for the treatment of the widespread condition of headaches and for the patients affected. It was jointly developed by the partners Kiel Pain Clinic and Techniker Krankenkasse (a German health insurance company). For the first time, this concept enables nationwide, cross-sectoral networking of outpatient and inpatient therapy. The latest scientific findings on the modern treatment of migraines and headaches directly benefit those affected. Comprehensive, collaborative care, increased knowledge, innovative information exchange between all involved parties, and joint work using precisely defined treatment pathways form the basis for modern and efficient treatment outcomes. A national network of general practitioners and outpatient and inpatient pain therapists in practices and hospitals works hand in hand to optimally alleviate pain across disciplines and sectors using modern methods. The participating professional groups treat patients according to current guidelines and the latest scientific standards. Outpatient, rehabilitative, and inpatient therapies are closely coordinated and integrated in their timing. The quality of the treatment is documented through continuous scientific research, and its sustainable cost-efficiency across all sectors of the healthcare system is confirmed through analysis of direct and indirect costs. This concept has completely restructured the care of the widespread condition of headaches nationwide. An innovative national treatment network has been created and implemented, serving as an international model for effective and modern coordinated therapy that effectively alleviates pain and sustainably reduces costs.
What measures does the treatment include?
Prof. Göbel: Basically, we address all components involved in headaches simultaneously. To use an analogy: If a bicycle tire has five punctures, we patch all five holes at once, otherwise it won't hold air and we won't make any progress. Specifically, this means first making an accurate headache diagnosis, as there are now over 250 main types of headaches. These can be treated in a targeted manner through specialization. Important components of therapy, using migraine as an example, include identifying headache triggers, reducing stress, irregular lifestyle, excessive energy expenditure, mood problems, and sleep disorders, optimizing nutrition—for example, with regard to ensuring an adequate energy supply to the nerve cells—and building self-esteem.
On the physical side, treatment addresses hormonal imbalances, muscular hyperactivity, factors contributing to chronicity outside the brain, and accompanying illnesses. Patients are also provided with a well-tolerated medication regimen that allows them to reliably manage pain during an attack. All therapy is based on the latest scientifically evaluated findings.
Why do your patients need the help of a specialized clinic and a nationwide network of pain therapists?
Prof. Göbel: Headaches affect people very differently. At one end of the spectrum is a headache as a minor discomfort, at the other a life-altering illness: Severe, persistent attacks of pain lead to inability to work, children miss half a year of school and cannot complete their education, and relationships break down. It can result in long-term disability, social withdrawal, depression, high blood pressure, liver disease, and many other serious physical illnesses.
The motivation is to organize specialized, local treatment for these patients. We have therefore established a nationwide network of approximately 400 specialists with particular headache qualifications, who can be contacted through TK (Techniker Krankenkasse) or found online via a map of Germany. These pain therapists offer patients highly qualified treatment locally.
However, a group of severely affected patients requires even more extensive therapies. These are offered centrally by the Kiel Pain Clinic for the entire country. If necessary, patients can be removed from their daily routines and receive individually tailored treatment at our clinic. The local network partners then continue the therapy for a year – this is the optimal outcome in pain management.
Over 1000 patients have now been treated under the new care model. What are your experiences?
Prof. Göbel: The project is very successful and is used extensively throughout Germany. The patients' quality of life improves sustainably: psychologically, physically, and socially. Those affected return to work, and periods of sick leave decrease significantly. This positive trend continues even after the therapy. The patients are able to take control of their lives again.
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