Zusammenfassung
Sowohl die Sozialisation als auch das Geschlecht des Schmerzpatienten scheinen Bedeutung für die Art und Schwere der Symptome, den Umgang mit ihnen sowie die Prognose und den Therapieerfolg zu haben. Interkulturell sind die unterschiedliche Wahrnehmung und sprachliche Umsetzung körperlicher und emotionaler Funktionen und Beschwerden von elementarer Bedeutung, wenn man Schmerzklagen von Menschen mit Migrationshintergrund verstehen will. Wesentlich ist, dass die schon mit Patienten aus unserem Kulturkreis schwierige Gestaltung der gelingenden Arzt-Patient-Beziehung dadurch weiter problematisiert ist, weil das Verstehen maßgeblich durch den kulturellen Hintergrund geprägt wird. In epidemiologischen Studien überwiegt das weibliche Geschlecht fast einheitlich hinsichtlich der Prävalenz von Schmerzen und Schmerzerkrankungen. Allerdings weisen neuere Untersuchungen darauf hin, dass diese Unterschiede möglicherweise geringer als primär angenommen und möglicherweise sekundär durch Begleiterkrankungen und psychosoziale Faktoren erklärbar sind, die bei Frauen vermehrt auftreten, z. B. Depressionen und Katastrophisierungsneigung. Biologische Faktoren scheinen zwar von Bedeutung zu sein; dies spiegelt sich aber weniger in simplen somatischen Veränderungen, z. B. verminderten Schmerzschwellen, wider als in komplexen genetischen, psychologischen und hormonell bedingten Interaktionen. Bildgebende und psychophysiologische Untersuchungen deuten auf eine besondere Bedeutung der Beeinflussung hemmender Einflüsse aus dem zentralen Nervensystem hin. Inwieweit diese Aspekte klinische Relevanz haben und welche therapeutischen Aspekte bei Männern und Frauen möglicherweise differenziert beachtet werden müssen, ist aber bisher noch ziemlich unklar. Vor allem humane experimentelle Untersuchungen und Studien mit Patienten sind erforderlich, um hier Klarheit zu schaffen.
Abstract
Cultural setting and sex and gender of the patient are important factors affecting the occurrence, severity, clinical course and prognosis of pain and pain-related diseases. Intercultural differences in the perception and verbal expression of symptoms and emotional function are fundamental and it is important to realize these differences in order to understand patients with a migration background. A trusting doctor-patient relationship is generally very sensitive and it is even more difficult to establish when differences in the cultural background impair mutual understanding. Regarding sex and gender there is evidence that females are more susceptible to developing chronic pain conditions, experience more severe pain and respond differently to pain therapy; however, results of recent studies indicate that females are not that different to males when comparing several modalities of experimental pain (although some differences exist). Similarly, sex and gender differences in postoperative pain seem to exist but the differences are relatively small when pain scores are compared. Other aspects, such as the response to analgesics and role of psychosocial factors should be addressed when sex and gender aspects are studied. Similarly, sex and gender differences in the prevalence of chronic pain exist but the results of some studies, e.g. those controlling for confounders, are not very clear. Research is needed to delineate the role of specific aspects affecting sex and gender differences and the underlying mechanisms (e.g. reduced inhibitory control, hormones, psychological aspects and social factors). Altogether, we need to open our minds to some intercultural and sex and gender aspects in the clinical setting. For sex and gender differences we may need a more biopsychosocial approach to understand the underlying differences and differentiate between sex and gender and sex and gender-associated aspects for acute and chronic pain.
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M. Schiltenwolf und E.M. Pogatzki-Zahn geben an, dass kein Interessenkonflikt besteht.
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Schiltenwolf, M., Pogatzki-Zahn, E. Schmerzmedizin aus einer interkulturellen und geschlechterspezifischen Perspektive. Schmerz 29, 569–575 (2015). https://doi.org/10.1007/s00482-015-0038-9
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DOI: https://doi.org/10.1007/s00482-015-0038-9
Schlüsselwörter
- Geschlechtsbezogene Unterschiede
- Arzt-Patient-Beziehung
- Interkulturelle Unterschiede
- Epidemiologie
- Migrationshintergrund