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Konservative Therapie beim unspezifischen, chronischen Kreuzschmerz

Evidenz der Wirksamkeit – eine systematische Literaturanalyse

Conservative treatment of nonspecific, chronic low back pain

Evidence of the efficacy – a systematic literature review

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An Erratum to this article was published on 13 June 2016

Zusammenfassung

Fragestellung

Welcher konservative Therapieansatz bei unspezifischem chronischem Kreuzschmerz (UCK) zeigt nach der gegenwärtigen Literatur eine wirksame Effizienz?

Methoden

Literaturrecherche aktueller, randomisierter, klinischer Studien, Reviews sowie Metaanalysen aus der Cochrane Library und der Medline-Datenbank der Jahre 2004–2015 in deutscher oder englischer Sprache. Die Suche fokussierte sich auf konservative Therapieansätze, welche in den aktuellen nationalen Versorgungsleitlinien „Thema Kreuzschmerz“ als Optionen vorgestellt werden. Die Wirksamkeit jener wird hinsichtlich ihrer Evidenz untersucht.

Ergebnisse

Im Rahmen der Literaturrecherche wurden 4657 Publikationen identifiziert, davon konnten 85 in die Auswertung eingeschlossen werden.

Bettruhe, TENS, Massagen, Orthesen, Rückenschule und Antidepressiva zeigen keine Evidenz bezüglich einer Wirksamkeit bei UCK. Infiltrationen und Injektionen, Analgesie mit NSAR oder Opioiden und Thermotherapie sind kurzfristig wirksam, zeigen jedoch keinen nachweisbaren Effekt nach einem Behandlungszeitraum von mehr als 6 Wochen. Einzig die Kräftigungs- und Bewegungstherapie zeigt eine evidente langfristige Wirksamkeit in der Behandlung des UCK.

Fazit

Eine signifikante positive mittel- bis langfristige Wirkung konnte nur von wenigen konservativen Therapien bei unspezifischen chronischen Kreuzschmerzen gezeigt werden. Einen kurzfristigen Effekt haben NSAR, Opiate, Thermotherapie und Injektionstherapie. Diese sollte nach individueller Abwägung eingesetzt werden, um eine Alltagsfunktionalität herzustellen und den Spontanverlauf zu überbrücken. Langfristig scheint alleinig die Bewegungstherapie einen evidenten Behandlungserfolg zu haben. Insgesamt sollte bei therapierefraktären Patienten eine multimodale Therapie angestrebt werden.

Abstract

Objectives

Non-specific chronic low back pain (NSCLBP): Which conservative therapy shows an evident effectiveness – A review of the current literature.

Materials and methods

Our results are based on literature reviews of current randomised control studies, reviews and meta-analysis drawn from the Cochrane Library and Medline-Database between the years 2004 until 2015. German and English Studies were included. We focused on different conservative Treatments of NSCLBP, which are listed at, the NVL-Guidelines. Based on the given evidence we evaluated their effectiveness.

Results

As part of the review we identified 4657 Publications, 85 were included in this study. Therapeutic options such as bed rest, TENS, Massage, Spine Supports, Back Schools and Antidepressants showed no evident effectiveness. Injections, NSAR analgesic therapy, Thermotherapy and Opioid analgesic therapy indicated a short-time effectiveness. A long term success (> 6 weeks) however, can not be shown. Only the Movement therapy can, in the summation of the included studies, postulate an evident (Evidence Level I) long-term effect treating NSCLBP.

Summary

Only a few therapy options indicate a significant evident effectiveness for treating NSCLBP conservatively. At short notice methods such as injection therapy, thermo-therapy and analgesic therapies with NSAR and/or opioids help coping the acute phase. In the long term only movement therapy seems to provide an evident effectiveness.

In the case of therapy-refractory NSCLBP a multimodal therapy should be considered.

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Abb. 1

Abbreviations

AWMF:

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

LoE:

Level of Evidence

NSAR:

nichtsteroidale Antirheumatika

NVL:

Nationale Versorgungsleitlinie

RCT:

Randomized controlled trail

TENS:

transkutane elektronische Nervenstimulation

UCK:

unspezifischer chronischer Kreuzschmerz

WIdO:

Wissenschaftliches Institut der AOK

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Joseph-Stelzmann-Str.24, 50931, Köln, Deutschland

    J. Bredow, K. Bloess, J. Oppermann, C. K. Boese, L. Löhrer & P. Eysel

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Bredow, J., Bloess, K., Oppermann, J. et al. Konservative Therapie beim unspezifischen, chronischen Kreuzschmerz. Orthopäde 45, 573–578 (2016). https://doi.org/10.1007/s00132-016-3248-7

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