Welcome to Kiel Pain Center

Center for Neurological and Behavioral Medicine!

This website is designed to provide you with general information about Kiel Pain Center and about your stay in our clinic. More than 10 million people in Germany alone suffer from stubborn and disabling pain. But it isn’t just the patient who suffers – the patient’s family and friends are affected as well. Pain also affects employers, insurance providers and productivity in general.

Pain can affect anyone. Although persons such as Paul the Apostle, Thomas Jefferson, Karl Marx and Marie Curie may have had very different worldviews, they did share one thing: chronic pain. In particular, severe headaches are one of the most widespread ailments in the general public. For one in four Germans, migraines alone account for 36 lost days of life per year. Untreated pain destroys the lives of the affected persons. They may lose the ability to work, sleep, play with their children and function in relationships. Successful pain therapy can change this. However, undertreatment of pain is a silent epidemic. No one should have to suffer from unnecessary pain.

Patients often suffer from the fact that the cause of their pain cannot be found in common tests such as X-rays or blood tests. For the most common pain disorders, pain is caused by electrical or biochemical changes in the nerves, spinal cord or brain. This is known as the neurological aspect of chronic pain. Changes in behavior and living habits play an important role in the persistence of pain; this is called the behavioral aspect of pain disorders.

These processes often cannot be discovered with normal diagnostic methods in routine care; however, the pain is present and real. One of the greatest problems for persons suffering from pain disorders is finding a specialized facility for treatment. The result is frequent changes of physicians, hospital stays and rehabilitation programs without satisfactory pain relief. Uncontrolled self-medication and fruitless experiments with non-conventional alternative therapies are additional steps along the pathway of failed treatment.

Because of this unmet need, I founded the Kiel Pain Center for Neurology and Behavioral Medicine in 1997. At my prior position at the University of Kiel’s Department of Neurology, my responsibilities included managing the neurological outpatient pain clinic. It became clear that the patients who came there required special treatment. At that time, patients with chronic pain often required supplementary pain treatment during an inpatient stay due to highly acute co-existing diseases such as stroke, Parkinson’s disease and multiple sclerosis. Due to the high need for specialized pain therapy, I developed the concept of a center exclusively for the needs of patients with chronic pain. Our objective was to apply all available knowledge regarding the treatment of chronic pain for highly-specialized care of patients with chronic pain.

Since this concept was implemented in 1997, the Kiel Pain Center – unique in its conception – has offered outpatient and inpatient neurological and behavioral treatment for patients with chronic pain. The employees at the Kiel Pain Center are specialists in various medical and psychological disciplines. They work exclusively with the needs of patients with chronic pain, applying the latest scientific research in their treatment. We also perform research in the fields of neurological pain disorders, migraines and other headaches. Our main areas of treatment include migraine and headache disorders, pain disorders of the musculoskeletal system, pain due to disorders of the peripheral and central nervous system and pain due to accidents with nerve injury. Our goal is to apply the latest international knowledge regarding the treatment of chronic pain directly to our treatments, allowing for highly-specialized care of patients with chronic pain.

A multi-year, independent scientific analysis by the public insurance provider AOK Schleswig-Holstein and the Association for Systems Consulting in the Health Sector has confirmed that the Kiel Pain Center’s treatment modality is successful in long-term relief of pain. This allows patients to resume social and professional activities. In addition, the direct and indirect costs of chronic pain diseases have been significantly lowered. Over the last ten years, the team at Kiel Pain Center has performed more than 10,000 inpatient treatments and more than 50,000 outpatient treatments. More than 70% of the treated patients came from other regions of Germany and abroad.

The concept of the Kiel Pain Center is based on modern developments in medicine, such as integrated care. Integrated care means that treatment is not limited by the separation of various specialties. The traditional lines between outpatient and inpatient care have also been relaxed. Experts in various medical specialties work together to treat patients using modern scientific methods. Outpatient and inpatient treatment is closely linked.

The treatment network initiated in 2007 with the public insurer Techniker Krankenkasse, based on our experiences, now provides treatment all across Germany. This network is the first nationwide, coordinated treatment network and is intended to improve treatment quality in all regions. Kiel Pain Center is responsible for nationwide coordination of the network, including managing comprehensive pain information, continuing education and sharing of experience among therapists.

With the AOK Schleswig-Holstein, the coordinated care network has been implemented in the entire state. Many additional regional and national health insurers also use these innovative treatment concepts for their policyholders.

This patient information is intended to provide an introduction to our clinic. Here, you will find information about the treatment concept and processes. Please do not hesitate to contact us directly with additional questions.

Yours truly,
Prof. Dr. Hartmut Göbel

In the public eye:
Help for chronic headache and migraine: New Integrative Healthcare Network in Germany

Headache is one of the most widespread forms of suffering in our society; millions of people are affected by it every day. Many have undergone multiple therapies, without long-term success. According to a recent study, the economic burden in Europe resulting from sub-optimal headache treatment amounts to 20 billion euros (£ 14 billion). The same amount is the yearly headache treatment expenditure in Germany. Migraine alone leads to 270 lost working days per 1000 workers per annum, and an additional 920 days are lost through tension type headache.

In the Federal Republic of Germany, the healthcare system has been historically influenced by the care provider and health administration rather than being led by successful medical and scientific treatment structures. 11 sectors of healthcare emerged, independently budgeted. Until the 90’s, innovation was thought to be limited to evolving therapies, but the structure and financing of the healthcare system was not deemed important for treatment success. With the Healthcare modernisation law in 2004, the situation changed, and care providers were now allowed to make sector-overreaching contracts with the health insurance companies. These integrative healthcare networks are regarded as the future of healthcare.

Integrative headache network in Germany

A new nationwide network has now been set up in Germany under the initiative of the Kiel Neurological Pain Center (Schmerzklinik Kiel) in collaboration with the University Hospital Schleswig-Holstein (UKSH) and about 400 independent pain therapists across Germany to tackle inefficiencies in the current treatment system for chronic headache and migraine. At the heart of it lies the intertwining of the two main sectors of healthcare: outpatient and inpatient care, which has traditionally remained segregated. Integrative healthcare results in an optimisation of the therapy through collaboration between general practitioner, consultant and hospital.

The comprehensive concept in the treatment of chronic headache and migraine entails three steps:

• Phase 1 involves the diagnosis of the pain form and classification of its severity by a regional pain therapist (secondary care) or general practitioner (primary care).
• Phase 2, in cases of severe pain forms, sees an inpatient treatment in the Kiel Pain Centre (tertiary care) with a comprehensive, multidisciplinary approach (see below).
• Phase 3 involves the patient being accompanied for an additional year by their regional pain therapist. Regular check-ups are made which serve to continuously adapt the therapy.

The network is specialised for an interdisciplinary treatment of patients with severe chronic headaches. The target group therefore includes patients suffering from severe and frequent migraine, chronic tension-type headache, cluster headache, medication-overuse headache, posttraumatic headache, neuralgias, and rare headache forms without established treatment guidelines.

Patients who receive treatment in this network receive a long-term therapy of at least one year duration, during which their local general practitioner or pain specialist works hand in hand with the pain specialists at the Kiel Pain Centre. In the inpatient phase (Phase 2), a comprehensive multidisciplinary approach with interdisciplinary therapy forms is applied, combining patient information, relaxation therapies, behavioural treatment and drug treatment. Interdisciplinarity is achieved through the close collaboration between neurologists, pain specialists, psychologists and physiotherapists.

The new approach is proving very successful, patients are successfully relieved of their burden, lost days of work are reduced and the post-treatment costs are minimised, suggesting that the treatment is also cost-effective.

Linking up health care sectors

The integrative network links up secondary health care teams, sets treatment standards, and allows direct exchange of ideas and treatment recommendations within the network. An increased cooperation between regional general practitioners (primary care), pain specialists (secondary care) and the Kiel Pain Centre as a specialised institution (tertiary care) results from this network, so the network itself directly forms an interface between these health care teams.

Integration increases treatment efficacy

Without it, the health care teams would have otherwise worked separately without much communication. One patient characterised the situation as follows: the general practitioner refers him to a consultant, who first makes an x-ray of the cervical spine. Since the consultant is not entirely sure of the diagnosis, he sends the patient to the hospital. After finally receiving an appointment there, another radiograph is made. Apart from being annoying for the patient, it also costs much time and money.

Evaluation

In the case of the Kiel Pain Centre, clinical and economic evaluation has been done. The clinic was founded in 1995 and already then, an integrative therapeutic approach was realised on a regional scale, involving collaboration with pain specialists in the local county (Schleswig-Holstein). An external and independent evaluation of the treatment efficacy showed, that the integrative concept achieved all its goals in the treatment of patients suffering from severe chronic pain: long-term pain reduction and improvement of working capacity while being cost-effective at the same time. According to one evaluation study, the pain intensity and days with pain of treated patients decreased significantly two years after treatment in the Kiel Pain Centre and inability to work decreased by two weeks per annum after the treatment. The post-treatment costs of Kiel Pain Clinic patients were also significantly less than those of the comparison group. In this comparison group, treatment results were compared which the results of patients that were treated in the traditional uncoordinated sectoral health care system, however with identical biographical data and diagnoses. In the light of this data, the integrative approach proofs to be very effective.Healthcare in society is delivered through different sectors, who often work independently of one another, unless efforts are made to integrate them.  Integration increases treatment efficacy while being cost-effective at the same time.