title: [Pain - a neglected neurological issue].
abstract: Chronic pain represents a great challenge; according to epidemiological data increasing numbers of patients should be expected. Based on recent advances, a better understanding of the pathophysiology of chronic pain has been achieved and neurologists have made a major contribution to this understanding. Chronic pain is accompanied by substantial maladaptive plastic alterations in both the peripheral and central nervous systems; therefore, neurological knowledge is of paramount importance for pain therapists but this contrasts with the current treatment situation of pain patients in Germany. There are basically too few departments and practices undertaking treatment, and neurologists are an exception in most pain centers. Furthermore, due to economic reasons neurological hospitals are currently experiencing a dearth of inpatients suffering from chronic pain. Diagnostic and/or treatment procedures for neurological pain entities (e.g. headaches or neuropathic pain) are insufficiently represented in the German diagnosis-related groups (DRG) reimbursement system and the obstacles for an efficient pain therapy in neurological practices are too high. Finally, there are too few academic positions for pain medicine in neurological hospitals; therefore, career opportunities for motivated young neurologists with an interest in pain are lacking. In order to address the unmet therapeutic needs of patients with chronic pain there is a high demand for (i) establishment of departments for neurological pain medicine, (ii) modification of the German DRG system and (iii) education of young neurologists with expertise in pain. Pain medicine in particular should be especially appealing to neurologists .
authors.affiliation: Klinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland. Frank.Birklein@unimedizin-mainz.de.
authors.forename: F
authors.initials: F
authors.lastname: Birklein
authors.affiliation: Klinik für Neurologie, Universität Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Baron
authors.affiliation: Migräne- und Kopfschmerzklinik, Königstein/Taunus, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Gaul
authors.affiliation: Klinik für Neurologie, Klinikum Fürth, Fürth, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Maihöfner
authors.affiliation: Abteilung für Neurologie und Schmerztherapie, Rommel-Klinik GmbH, Bad Wildbad, Deutschland.
authors.forename: O
authors.initials: O
authors.lastname: Rommel
authors.affiliation: Neurologische Klinik und Poliklinik & Deutsches Schwindel- und Gleichgewichtszentrum IFB, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Straube
authors.affiliation: Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Tölle
authors.affiliation: Praxis für Neurologie, Kiel, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Wasner
mesh_terms: D059350:Chronic Pain / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D003695:Delivery of Health Care / Q000639:trends; D003953:Diagnosis-Related Groups; D005544:Forecasting; D005858:Germany; D006301:Health Services Needs and Demand / Q000639:trends; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D058069:Neglected Diseases; D009420:Nervous System / Q000503:physiopathology; D009422:Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D009462:Neurology / Q000193:education / Q000639:trends; D009473:Neuronal Plasticity / Q000502:physiology; D059408:Pain Management / Q000379:methods / Q000639:trends; D010348:Patient Care Team / Q000639:trends; D013038:Specialization / Q000639:trends
keywords: Chronic pain; Headache; Neuropathic pain; Outpatient care; Pain management