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Multimodal, polypragmatisch und kostenintensiv

Rückenschmerzbehandlungen auf dem Prüfstand

Multimodal, polypragmatic, and very costly

Treatments for low back pain under review

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Zusammenfassung

Die angebotenen Therapien für Rückenschmerzen sind vielfältig, von singulären Interventionen bis hin zu komplexen chirurgischen Eingriffen und aufwendigen multimodalen Therapieprogrammen. Wie sieht es aber mit der aktuellen Evidenz aus? Ist alles, was teuer ist, auch effektiv? In diesem Review wird eine Übersicht über gängige Einzeltherapien und Komplexbehandlungen mit, soweit möglich, einer Kosten- und Evidenzanalyse gegeben. Aus der aktuellen Evidenz lässt sich insbesondere bei Patienten mit chronischen und chronifizierungsgefährdeten Rückenschmerzen die Notwendigkeit zur frühzeitigen multimodalen interdisziplinären Diagnostik ableiten. Monomodale Diagnostik- und Therapiekonzepte sind oft nicht zielführend. Weitere Forschung in Richtung Subgruppenbildung wäre sinnvoll, um gezielte Therapieprogramme zu ermöglichen. Diagnostische Bildgebung, interventionelle sowie operative Verfahren sollten mit einer größeren Zurückhaltung angewandt werden.

Abstract

There are many therapies for low back pain, from simple interventions up to complex surgical procedures and multimodal therapy programs. But what does the medical evidence say? Are expensive therapies worth the money they cost? This review gives an overview of frequently used interventions and complex therapy programs and as far as possible the medical evidence and costs. Reviewing the scientific evidence the need for early interdisciplinary multimodal diagnostics in patients with chronic low back pain becomes evident. Single interventions are often not indicated. Further research is needed to define subgroups for special treatment programs. Radiography, interventional pain therapies, and operations should be used with great care.

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    K. Niemier

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Niemier, K. Multimodal, polypragmatisch und kostenintensiv. Manuelle Medizin 50, 16–27 (2012). https://doi.org/10.1007/s00337-011-0888-x

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