Welcome to Kiel Headache and Pain Center

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.

The Kiel Headache Center and German Headache Treatment Net

A first specialized headache centre was established at the Department of Neurology at Kiel University Hospital in 1985 by Dieter Soyka, founding president of the International Headache Society. Before then, coordinated treatment of headache did not exist in Germany. Treatment structures had traditionally been shaped by care providers and health care administrators rather than scientific evidence-based treatment requirements. 11 separate healthcare sectors had developed in the past, which acted independently in legal and financial terms. Responsibility of a care provider only covered the individual sector; reimbursement systems changed several times during a patient career and provided incentives which were opposed to high treatment quality. Innovations in healthcare until then were only thought to include medical-therapeutic advances, without considering the importance of structure, coordination and financing of services for the health of patients.

This healthcare system, based on separated sectors and universal contracts, contributed to the chronification and persistence of headache disorders. Due to lack of efficiency, many patients with chronic headache searched for help outside of the professional system. Thus over many years, further chronification of headache disorders took place, severe organic and psychic complications resulted in more expensive medical treatment requirements.

The German health care policies in the 1990’s did not allow for an extension of healthcare structures, as funds were already stretched. An exception was made only for particularly innovative treatment concepts. The legal basis for such pilot projects was made in 1995 (§ 63 ff Social Security Code) to subsequently evaluate them for clinical efficacy and cost-saving potential in comparison with conventional care.

Against this backdrop, the scientific concept of the Kiel Headache and Pain Center for Neurological and Behavioral Medicine was developed and implemented in 1997. A pilot project was set up for the treatment of patients with headache across sectors and disciplines for the very first time in the German state of Schleswig-Holstein. To do so, a specialized neurological and behavioral-medicine headache centre was established. The academic staff includes neurologists, psychiatrists, anesthetists and psychologists trained in special pain therapy. Further groups include physical therapists, social workers and specially-trained headache nurses. In addition, all conservative and surgical specialties could be consulted at any time from nearby hospitals. The Kiel Headache Center provides a multi-disciplinary treatment according to modern scientific standards for children and adults. A coordinated pre- and long-term follow-up is provided with the help of practice-based doctors that are part of the treatment network. The Center collaborates with patient support groups, health insurers and healthcare politicians to further develop treatment structures and processes. Pre- and postgraduate medical health care professionals are educated and trained. Online educational facilities for patients, the public and for health care professionals are developed and maintained in parallel. Active research includes the initiation and implementation of collaborative national and international research projects and the continued development of coordinated treatment structures. The Center also aims to directly integrate scientific, educational and organizational fields of headache care. Approximately 80 employees handle 8,000 outpatient and 1,500 full inpatient attendances per year. The treatment is coordinated through specific structures and includes long-term outpatient follow-up by practice-based specialists and GPs.

Integrative headache network in Germany

Patients treated include those with resistant headache, severe cluster headaches and other TAC’s, severe secondary headaches, trigeminal and other cranial neuralgias, headaches with severe physical and/or psychological co-morbidities, severe medication-overuse headache, specific diagnostic problems and specific treatment complications amongst others. Normally, severe and complex co-morbidities such as medication-overuse headache, medication intolerances, psychic and social complications as well as organ damage are seen. It is particularly these patients who require special coordinated headache care across sectors in a supra-regional headache center. The headache centre with integrated treatment network is characterized by:

• Services are directed at the patient needs.
• Indication-specific cooperation of regional and supra-regional specialised high-volume-providers.
• Medical treatment within a coordinated network throughout an entire patient career.
• Services provided are independent of insurance type.
• Transparency regarding services, costs and quality.
• Guarantee of a defined treatment success.

The scientific evaluation of this pilot project showed a sustainable clinical improvement of the treated patients and a parallel significant cost reduction compared to conventional care. The pilot project led to the creation of new national legal foundations for the creation of so-called “integrated care” (§ 140 ff Social Security Code). The integrated care of headache disorders, which so far had only covered one state, was expanded to the entire federal republic of Germany. To do so, contracts were concluded with the largest German statutory health insurance companies to develop a nationwide integrated treatment network for the first time. A national network of pain therapists seeing outpatients and/or inpatients in practices and hospitals collaborates across all sectors to reduce pain with the most up-to-date scientific and internationally evaluated methods. Outpatient, rehabilitative and full inpatient therapies are adapted and temporally coordinated . The concept encompasses a supra-regional coordinated treatment from regional centers, outpatient pain clinics and hospitals without any limits on types of disciplines and bureaucratic reimbursement structures. The integrated care comprises three phases:

• Phase I: Specialized diagnosis, professional screening, selection and realization of treatment paths across sectors, local treatment
• Phase II: Supra-regional neurological behavioral-medicine treatment across sectors.
• Phase III: Outpatient follow-up and evaluation, local monitoring of therapy success across sectors, takes place locally

For the realization, a nationwide network of practices experienced in headache treatment was created. The aim was the establishment of a comprehensive treatment network for all headache forms. More than 450 regional pain therapists as well as inpatient pain specialists collaborate in this way. Treatment is of the most up-to-date scientific standards. Treatment quality is permanently improved through continuous scientific evaluation as well as exchange and discussion of new ideas amongst network members. The lasting cost-effectiveness is confirmed through analysis of direct and indirect costs. Two years after starting, all large statutory health insurance companies in Germany have joined the treatment project. Patients are actively involved via patient support groups. The Kiel Headache Center serves patients nationwide, who cannot be adequately treated regionally after exhaustion of available resources in specialized practices and day hospitals. The concept is used extensively and has completely transformed health care provision for headaches nationwide. The referral criteria, provision of pre- and long-term follow up, as well as reimbursement by the health insurance companies are contractually agreed.

Evaluation and Outcome

Integration increases treatment efficacy

According to legal guidelines, the scientific evaluation and auditing is done by the health insurance companies, independently from the treating doctors. The evaluation documented the individual treatment paths and analyzed the effects of the integrated approach on service utilization, costs, work and social situation as well as on pain and quality of life. Data was acquisitioned from individual patient careers over 5 years prospectively. It was based on patient-related, anonymized service data across all sectors (Hospital acute inpatient and rehabilitative 500,000 data points, outpatient consultations 5 million data points, drugs 6 million data points, benefits in kind and care allowances 800,000 data points) as well as individual contributions and patient social background (700,000 data points). The service utilization across all sectors was analyzed over time, the resulting costs were calculated. As controls, patients treated conventionally with identical diagnosis, age and gender were identified. The integrated care could significantly lower the costs in all healthcare sectors: 21.5% for inpatient services, 31.5% for outpatient services, 50.6% for rehabilitative services. In the control group, outpatient costs fell by only 6.4%, while inpatient and rehabilitative costs rose by 19.9% and 34.6% respectively. Therefore, the conventional treatment leads to a significant cost increase, while the integrated care across sectors can achieve a significant cost saving.

Due to the income-dependent health insurance contributions in Germany, it was possible to analyze the development of income of patients with chronic pain disorders and compare this in different groups. Patients with severe headaches are disabled at work and achieve a significantly lower average income. Integrated care, by improving the headaches, allowed a continuous income improvement of 17.9%. Patients were able to resume work, become promoted and increase their income. The control group’s income fell by 8.1% in the same period. Severe chronic headaches without specific treatment lead to a relative income reduction. The result is a lower standard of living for the individual, less social and tax contributions for society. Integrated care in a specialized headache center can stop and reverse this trend.

Clinical improvement was monitored, amongst others, via SF-36. Before treatment commenced, patients showed a reduction in all domains of quality of life. Despite this marked reduction, integrated care could largely normalize their quality of life in comparison to the rest of the population. This normalization was lasting and could still be observed 2 years after treatment completion. Patient satisfaction with integrated care is very high. More than 85.4% are entirely satisfied, a further 13.9% are largely satisfied. 82.4% of patients would recommend integrated care entirely, a further 13.6% largely.

Modern integrated care contracts are characterized by acceptance of a guarantee for defined treatment success. This is based on the attestable treatment quality and its scientific evaluation. Due to the known treatment efficiency in the past, health care providers are able to guarantee the therapy’s efficacy. On the basis of this, risk sharing for treatment success can be contractually agreed to act as a motivator for patients, insurers and care providers. In the nationwide headache treatment network this is implemented in the form of a bonus malus system. The guarantee is operationalized via the patient’s capacity to work. In the case of lack of efficacy, a malus payment is returned to the insurance company. In case of prolonged capacity to work, the health insurance company pays a bonus premium to the health care providers. The evaluation so far shows that risk-sharing is a win-win-situation for all participants: in 81.6% of cases, a bonus was paid, a malus only in 18.4%. Treatment success means that long periods of unemployment are replaced by lasting capacity to work. This confirms clinical efficacy for patients and reduces costs for employers and insurers.