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Der Schmerz

, Volume 4, Issue 1, pp 1–6 | Cite as

Prävention chronischer Rückenschmerzen

Ein beitrag aus psychologischer sicht
  • H. -D. Basler
Übersichten

Zusammenfassung

Da die Behandlung chronischen Rückenschmerzes (Chronic Low Back Pain=CLBP) häufig wenig effektiv und zudem kostenintensiv ist, wird versucht, durch Identifizierung von Risikofaktoren im Frühstadium der Erkrankung und durch eine geeignete Frühbehandlung eine Chronifizierung akuten Rückenschmerzes (Acute Low Back Pain=ALBP) zu verhindern. Trotz methodischer Schwächen bisheriger Studien erscheinen folgende Annahmen gerechtfertigt: ALBP-Patienten sind dann besonders von der Chronifizierung bedroht, wenn vorausgehende Schmerzepisoden eruiert werden können, wenn die Patienten ihren Schmerz als weit ausgedehnt, diffus und tiefliegend beschreiben, wenn objektive körperliche Befunde nicht nachzuweisen sind, wenn sie unter Ängsten und Depressionen leiden und ein schlechtes Allgemeinbefinden beklagen. Ihre Gefährdung wird verstärkt durch einen geringen Bildungsstand und körperliche Inaktivität. Eine Frühbehandlung sollte bestehen aus möglichst kurzer Bettruhe und zeitkontingenter Medikation verbunden mit einem aerobischen Bewegungsprogramm. Weiterhin sollte eine Rückenschule kombiniert mit einem verhaltenstherapeutischen Training eingeschlossen werden. Ein solches Behandlungsprogramm kann aufgrund beschränkter Ressourcen zunächst allein Patienten mit einem hohen Risiko einer Chronifizierung angeboten werden. Weitere Forschung zur Prävention chronischen Rückenschmerzes ist dringend erforderlich.

Prevention of chronic low-back pain. Article from the psychological point of view

Abstract

Treatment of chronic low back pain (CLBP) is not only expensive, but is frequently not totally effective. For these reasons, it is important that the risk factors that correlate with the development of chronic pain be considered at the early stage of acute low-back pain (ALBP) in order to implement early treatment to prevent the condition from becoming chronic. Although most of the studies in this field suffer from methodological problems, it appears that the ALBP patients who carry the highest risk of becoming chronic are those who report previous pain episodes, who describe their pain as extending over a wide area of their body and as deep and central, who display no objective findings, who suffer from anxiety and depression, and who “always feel sick.” The risk in these patients is further increased when they have a lower educational level and are physically inactive. The recommended early treatment includes shorter periods of bed rest, time-contingent rather than pain-contingent medication, aerobic exericises, education in body mechanics, and behavioural training. In light of the need to contain costs, a program for the prevention of chronic back pain can only be provided for those ALBP patients with an increased risk of having CLBP. Further research on the prevention on CLBP is needed.

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Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • H. -D. Basler
    • 1
  1. 1.Institut für Medizinische PsychologiePhilipps-UniversitätMarburg

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