In Germany, around 23 million people suffer from a chronic pain disorder with somatic and psychological factors that lead to significant psychosocial and professional limitations.1 Of these, four million are seriously affected and require specialist care.two In addition to the significant burden of disease, the resulting economic damage is immense – estimated at up to €38 billion per year.
These four million patients in Germany who suffer from severe and terminal chronic pain have around 1,300 qualified pain therapists who work according to defined quality standards. These figures show that only around ten percent of patients with terminal chronic pain can be treated by qualified pain therapists.3
In Germany, it takes an average of four years between the first symptoms of chronic pain and the start of specialist analgesic treatment.4
According to a recent survey of 1,000 people by Boston Scientific, 41% of 18- to 34-year-olds in Germany live with chronic pain without a medical diagnosis.5 The number of affected patients is expected to continue to increase and at the same time the number of patients undergoing treatment will continue to decrease. This also shows the importance of the work of the German Society for Pain Medicine eV. The society advocates concrete improvements in the care of patients with acute and chronic pain.
Troubled Middle Ages
The problem begins with medical studies: here, pain medicine was introduced as mandatory knowledge relevant for examinations in 2016. There is no uniform curriculum for students. It was not until November 2023 that a chair for pain medicine, the first and so far only such chair in Germany, was established at the Medical Faculty of the University Hospital Würzburg (UKW).
Compared to other groups of physicians, pain doctors have a higher average age. Within five years, approximately 50% of currently working pain doctors will retire.
In its “Expert report on the further development of the requirements planning within the meaning of Sections 99 et seq. of SGB V to ensure statutory health care” from 2018 and subsequent resolution, the Federal Joint Committee (G-BA) made clear demands to be taken into account. formulated a separate, expert assessment of pain therapists in general specialist medical care.6 However, despite the increasingly difficult supply situation, implementation has still been pending for almost six years; pain medication is still an “additional deadline”. This in turn makes requirements planning more difficult: according to the law, there are no additional designations!
Furthermore, young specialists complain about inadequate pay conditions and complicated regulatory frameworks in pain medicine.
Why does it depend so much on demand planning?
What is urgently needed is the training of young doctors, starting with a curriculum that must be applied to all during their studies.
After completing the studies, specialist training is required: here the implementation of the G-BA report must be required. Only with a specialist title can requirements planning and further training be supported. Particular attention must be paid to demand planning. This is regulated in paragraphs 99 to 105 of SGB V. On this legal basis, further details are regulated in the requirements planning guidelines. There are four levels of care to which groups of doctors are assigned according to their specialist designations: general medical care, general specialist care (according to the 2018 report (see above), this would include specialist pain medicine), specialist specialist care or separate specialist care.
If there is no legal change here, painkillers will continue to be ignored in demand planning.
National funding? Unfortunately none!
The promotion of continuing education in private practice also needs to be reformed. According to the National Association of Statutory Health Insurance Physicians (KBV) (online from 15 July 2024): “In addition to general medicine (at least 7,500 places), continuing education in other disciplines (maximum 2,000 places) is supported. The KVs determine which subjects these are together with the local health insurers. This gives them the opportunity to continue training doctors in the specialist groups that are particularly needed in the outpatient sector in the region.
In all KV areas, the further training of pediatricians and adolescent doctors is financially supported. Further training in ophthalmology, gynecology and obstetrics, skin and venereal diseases, ENT medicine, neurology as well as psychiatry and psychotherapy is also supported almost everywhere. In some KV districts, disciplines such as surgery, child and adolescent psychiatry and psychology, psychosomatic medicine and psychotherapy, urology, neurology as well as psychiatry and psychotherapy are also supported.”7
Further training in pain medicine is only financed in the area of KV Westfalen-Lippe. However, this would be urgently needed in view of the increasing number of affected patients and the decreasing number of qualified pain therapists in all KVs nationwide. Politics and self-administration have a duty here.
Furthermore, the planned hospital reform will result in more pain relief facilities falling victim. This means a further deterioration in care for those affected and a further reduction in training opportunities for aspiring pain physicians.
Solutions
1) Education and further training: The DGS already offers a range of further training options. From the annual German Pain and Palliative Care Day, to various curricula, including for obtaining the additional qualification in special pain therapy or basic psychosomatic care, to training as a specialist assistant in algesology. Interested parties can also find information on the topic in the podcast “Pain Medicine Concrete”, in the DGS app or on the DGS homepage www.dg Pain Medicine.de.
A general curriculum for students should be established. The DGS offers its support here.
two) But politics and self-administration must also act: financial support for the training of young pain doctors is a reasonable demand. Specific financial support for doctors in further training should be made mandatory.
3) The introduction of a “pain medicine specialist” is urgently needed to care for affected patients. The DGS is convinced that only the creation of a pain medicine specialist, as called for in the report commissioned by the Federal Joint Commission and in the report adopted in 2018, can ensure reliable demand planning in the area of pain medicine.
The Federal Medical Association, the National Association of Statutory Health Insurance Physicians and politicians are equally needed here.
A warning:
For reasons of better readability, gender-specific endings have been omitted.
It is expressly stated that in all passages of the text where individuals or groups of people are mentioned, people of all genders are always understood.
1) Hauser et al. (2014): Chronic pain, painful disease and satisfaction of people affected with pain treatment in Germany. In “The Pain”, issue 5/2014
2) Drösler et al. (2017): Special report on the effects of morbidity-oriented risk structure compensation, Bonn.
3) Barmer (2016): Medical report Barmer GEK 2016. Online: https://www.barmer.de/presse/infothek/studien-und-reporte/arztreporte/arztreport-2016-1065350, last accessed July 2024
4) BVSD (2019): BVSD White Paper Pain Medicine 2019. Results of an online survey of doctors and psychological psychotherapists, page 19. Online: https://www.bvsd.de/wp-content/uploads/2019/05/ BVSD -Weissbuch_Schmerzmedizin_2019_final.pdf, last accessed July 2024
5) Boston Scientific (2023): Chronic pain survey in Germany reveals why it is underdiagnosed and what reasons prevent people from going to the doctor. Online: https://news.bostonscientific.eu/Chronische-Schmerzen-Survey-2023, last accessed July 2024
6) G-BA (2018): Resolution of the Federal Joint Committee to approve the final report “Expert report on the further development of the requirements planning within the meaning of Sections 99 et seq. SGB V to ensure statutory health care” Online: https://www.g-ba.de/downloads/39-261-3493/2018-09-20_Endbericht-Gutachten-Weiterentwickklung-Nedarfsplanung.pdf, last accessed July 2024
7) KBV (2024): Financing of continuing education. Online: https://www.kbv.de/html/themen_2861.php, last accessed July 2024