Rehabilitation for chronic pruritus

Rehabilitation for chronic pruritus - comprehensive help for sufferers

On 01.04.2025, PD Dr. med. Athanasios Tsianakas gave an exciting lecture on the topic of "Rehabilitation in chronic pruritus". Here you will find an overview of important aspects of the lecture.

What is rehabilitation and why is it important?
Rehabilitation (rehab) is often confused with a cure, but the two health services are very different. According to the definition of the World Health Organization (WHO), rehabilitation aims to specifically treat health and social restrictions caused by an illness. The main aim is to restore bodily functions and enable participation in social and professional life.

Causes and diagnosis of pruritus
The causes of chronic itching are varied and include skin diseases such as psoriasis and atopic eczema, internal diseases such as liver or kidney disease as well as neurological or psychiatric triggers.
A detailed diagnosis is usually first carried out on an outpatient basis or, in severe cases, on an inpatient basis as part of acute medical care. If the cause is found here, drug therapy is usually initiated. In acute care, however, time is often very limited and appointments are sometimes not sufficient to cover all facets of chronic pruritus. Intensified anamnesis discussions and diagnostics as part of rehabilitation can be a valuable addition here.

Rehabilitation as a sustainable therapy option
Rehabilitation usually lasts three weeks and offers a structured, interdisciplinary therapy program. It serves not only to alleviate the itching sensation, but also to treat possible accompanying illnesses such as diabetes, hypertension or hyperlipidemia.

Treatment options in rehab:
There are numerous treatments to choose from as part of rehabilitation. Below you will find an overview of possible therapies. During rehabilitation, an individual plan is then drawn up from the various options through collaboration between the patient and the specialist staff at the rehabilitation clinic.

• Dermatological therapies:
  • Local therapy with ointments and baths
  • Light and UV therapy (e.g. 6x per week, with increasing intensity)
  • Bath therapy, e.g. with sulphur mineral water, which has an anti-inflammatory effect
• Pain and movement therapy:
  • Physiotherapy
  • Strength training, equipment training, cycling and walking
  • Archery to strengthen the back muscles
• Psychological support:
  • Individual discussions on coping with the illness
  • Progressive muscle relaxation, Pilates and massages
  • Video glasses therapy with relaxing nature motifs to relieve itching
• Nutritional advice:
  • Focus on anti-inflammatory and healthy nutrition
• Social services counseling:
  • Support with professional reintegration
  • Support with applying for a pension
• Further measures:
  • Seawater spa
  • Application of heat packs and cupping techniques

Long-term success of rehab
As part of studies, numerous patients completed a large number of questionnaires during their stay. This allowed the effects of rehab to be measured and objectified. For example, it was shown that rehab not only significantly reduces the sensation of itching, but can also reduce anxiety and depressive symptoms. Another positive effect is the increase in quality of life. Over 90 % of patients stated in the survey that their expectations of rehabilitation had been met. Of course, the main aim of rehabilitation is to achieve a long-term improvement in pruritus as a result of the rehabilitation program. Here too, studies have shown that in most cases the therapeutic effect is sustained after discharge.

https://pubmed.ncbi.nlm.nih.gov/38935293/
https://pubmed.ncbi.nlm.nih.gov/36317589/

Who should take advantage of rehab?
Rehabilitation is particularly useful for:

• Patients who are not yet optimally medicated
• People with many concomitant diseases
• Patients with a high need for training on their disease

How and to whom do I submit a rehab application?
The assumption of costs and application depend on the current employment relationship and the insurance, i.e. statutory or private. In most cases, however, German pension insurance is responsible.

• Acute inpatient: The hospital's social services department can submit the application and follow-up rehabilitation will then begin within 14 days of discharge.
• Outpatient: The application can be submitted directly to the pension insurance or health insurance fund.
  • Employed persons → Application to the pension insurance fund
  •  Persons on pension → Application to the health insurance fund
• Application to the health insurance company: For those with statutory health insurance, there are specific forms that must be completed by the patient and the doctor treating them. For privately insured persons, an informal letter from the doctor is sufficient, which is submitted to the insurance company together with a letter from the patient.
• Officials: Applications are submitted via the aid.

If the application is rejected, it is worth submitting a written objection - often with success.
Please also note that you have the right to choose the clinic of your choice. You should therefore find out in advance which clinic is best specialized in your illness. You should then make a note of your preferred clinic in your application.

How often can I apply for rehab?

• Every four years for chronic diseases
• In particularly serious cases every two years

You have now received some information about rehab for chronic pruritus. If you think that rehab would help you, please discuss this option with your GP or dermatology specialist, who will be able to support you in the next steps.