Nobis H-G, Pielsticker A
Orthopädische Psychosomatik, MEDIAN-Klinik am Burggraben, Alte Vlothoer Str. 47-49, 32105, Bad Salzuflen, Deutschland.
Schmerz. 2013 Jun;27(3):317-24. doi: 10.1007/s00482-012-1289-3.
The term education can be understood here as informing the patient about the symptoms of the disease and the treatment. Patients with chronic pain require comprehensible information from the physician and beyond that esteem, encouragement and participation in decision-making processes. A successful patient-physician interaction is a quality ensuring element of the first degree. Imparting information in this context is of special importance which is not only derived from legal and ethical obligations but also from the scientifically proven therapeutic efficacy. A successful communication and relaying of information promotes motivation (compliance) and therapeutic effectiveness from both parties. Comprehensible explanations on biopsychosocial pain, interdisciplinary diagnostics and multimodal pain therapy reduce misunderstandings, false expectations and premature termination of therapy. The explanation of the biopsychosocial pain model opens for the patient a holistic view of the phenomenon of chronic pain and promotes self-help strategies. The question as to how and what should be imparted is not only a question of temporal resources but also represents a pedagogic challenge. The contents and experience imparted in the education are only substantially effective if they lead to a feeling of being personally affected due to being close to real life and plausibility and if the resulting multimodal treatment options can be implemented in the daily routine. The communicative duties of a physician are demanding and require practical training as can be reflected and practiced in the form of train-the-trainer seminars, workshops and Balint groups. It has been proven that competence in counselling techniques also has a positive effect on the experience of the physician in his profession. Pain patients can profit from information flyers, internet and interactive computer-based consulting systems if they fulfil basic standards, including topicality, neutrality, biopsychosocial understanding of disease and preventive information.
在这里，“教育”一词可以理解为向患者告知疾病症状和治疗方法。慢性疼痛患者需要医生提供易于理解的信息，此外还需要尊重、鼓励以及参与决策过程。成功的医患互动是首要的质量保证要素。在这种情况下传递信息尤为重要，这不仅源于法律和道德义务，还源于科学证明的治疗效果。成功的信息沟通和传递能促进医患双方的积极性（依从性）和治疗效果。对生物心理社会疼痛、多学科诊断和多模式疼痛治疗进行易于理解的解释，可减少误解、错误期望和治疗的过早终止。对生物心理社会疼痛模型的解释为患者打开了一扇了解慢性疼痛现象的整体视角之门，并促进自助策略。关于如何以及应该传递什么信息的问题，不仅是时间资源的问题，也是一项教学挑战。只有当教育中所传授的内容和经验因贴近现实生活和合理性而让患者产生切身感受，并且由此产生的多模式治疗方案能够在日常生活中得以实施时，这些内容和经验才会产生实质性效果。医生的沟通职责要求很高，需要进行实践培训，这可以通过培训师培训研讨会、工作坊和巴林特小组等形式来体现和实践。事实证明，咨询技巧方面的能力也会对医生的职业体验产生积极影响。如果疼痛患者信息手册、互联网和基于计算机的交互式咨询系统符合包括时效性、中立性、对疾病的生物心理社会理解以及预防性信息等基本标准，患者就能从中受益。
