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Nichtmedikamentöse Schmerztherapie bei chronischem Schmerz

Nonpharmacological pain therapy for chronic pain

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Zusammenfassung

Nichtmedikamentöse Schmerztherapie wird zur Behandlung chronischer Schmerzen am besten im Rahmen eines multimodalen Konzepts angewandt. Der vorliegende Beitrag stellt im Übelblick einige Therapieformen (Physiotherapie, Massage, manuelle Therapie, Elektrotherapie, Akupunktur und Musik) vor. Dabei zeigt sich, dass die Evidenzlage für eine empirisch nachgewiesene Wirksamkeit all dieser Therapieformen nicht sehr hoch und oft uneinheitlich ist. Dies bedeutet nicht, dass die Therapien nicht angewandt werden sollen, sondern dass sie individuell ausgesucht und an die Bedürfnisse des Patienten angepasst werden müssen.

Abstract

The treatment of chronic pain should be a multimodal combination of pharmacological and nonpharmacological components. This article describes some of the nonpharmacological treatment options and their evidence (e.g. physical therapy, massage, manual therapy, electrotherapy, acupuncture and music therapy). The evidence for an empirically detected effectiveness of all these forms of therapy is not very high and often inconsistent. Nevertheless, this does not mean that these forms of treatment should not be used but that they should be selected on an individual basis to improve the well-being of patients by being adjusted to their needs.

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Literatur

  1. Alvarez Bustins G, López Plaza PV, Carvajal SR (2018) Profile of osteopathic practice in Spain: results from a standardized data collection study. Bmc Complement Altern Med 18(1):129. https://doi.org/10.1186/s12906-018-2190-0

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ambrose KR, Golightly YM (2015) Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol 29(1):120. https://doi.org/10.1016/j.berh.2015.04.022

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bernatzky G, Presch M, Anderson M et al (2011) Emotional foundations of music as a non-pharmacological pain management tool in modern medicine. Neurosci Biobehav Rev 35(9):1989–1999. https://doi.org/10.1016/j.neubiorev.2011.06.005 (Epub 2011 Jun 16)

    Article  PubMed  Google Scholar 

  4. Boyd C, Crawford C, Paat CF et al (2016) Evidence for massage therapy (EMT) working group; the impact of massage therapy on function in pain populations—A systematic review and Meta-analysis of randomized controlled trials: part III, surgical pain populations. Pain Med 17(9):1757. https://doi.org/10.1093/pm/pnw101

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brosseau L, Yonge KA, Welch V et al (2003) Thermotherapy for treatment of osteoarthritis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004522

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bryans R, Decina P, Descarreaux M et al (2014) Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther 37(1):42. https://doi.org/10.1016/j.jmpt.2013.08.010

    Article  PubMed  Google Scholar 

  7. Canovas L, Carrascosa AJ, Garcia M et al (2018) Impact of empathy in the patient-doctor relationship on chronic pain relief and quality of life: a prospective study in Spanish pain clinics. Pain Med 19(7):1304–1314

    Article  PubMed  Google Scholar 

  8. Crane JD, Ogborn DI, Cupido C et al (2012) Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med 4(119):119ra113

    Article  CAS  Google Scholar 

  9. Cuenca-Martinez F, Cortes-Amador S, Espi-Lopez GV (2018) Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. Phys Ther Res 21(1):16. https://doi.org/10.1298/ptr.E9937

    Article  PubMed  PubMed Central  Google Scholar 

  10. Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie s2k-Leitlinie Gonarthrose der DGOOC. https://www.awmf.org/uploads/tx_szleitlinien/033-004l_S2k_Gonarthrose_2018-01_1.pdf. Zugegriffen: 18. Aug. 2018

  11. Deyo RA (2017) The role of spinal manipulation in the treatment of low back pain. JAMA 317(14):1418. https://doi.org/10.1001/jama.2017.3085

    Article  PubMed  Google Scholar 

  12. Ellis JM, Wells Y, Ong JSM (2017) Non-pharmacological approaches to pain management in residential aged care: a pre-post-test study, clinical. Gerontologist. https://doi.org/10.1080/07317115.2017.1399189

    Article  Google Scholar 

  13. Franke H, Franke JD, Fryer G (2014) Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. Bmc Musculoskelet Disord 15:286. https://doi.org/10.1186/1471-2474-15-286

    Article  PubMed  PubMed Central  Google Scholar 

  14. Furlan AD, Giraldo M, Baskwill A et al (2015) Massage for low-back pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001929.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  15. Geneen LJ, Moore RA, Clarke C et al (2017) Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011279.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gibson W, Wand BM, O’Connell NE (2017) Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011976.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Guétin S, Giniès P, Siou DK et al (2012) The effects of music intervention in the management of chronic pain: a single-blind, randomized, controlled trial. Clin J Pain 28(4):329. https://doi.org/10.1097/AJP.0b013e31822be973

    Article  PubMed  Google Scholar 

  18. Gutgsell KJ, Schluchter M et al (2013) Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial. J Pain Sympt Manag 45(5):822–831. https://doi.org/10.1016/j.jpainsymman.2012.05.008

    Article  Google Scholar 

  19. Hentschel HD, Schneider J (2004) The history of massage in the ways of life and healing in India. Wurzbg Medizinhist Mitt 23:179–203

    PubMed  Google Scholar 

  20. Hinman RS, McCrory P, Pirotta M et al (2014) Acupuncture for chronic knee pain. A randomized clinical trial. JAMA 312(13):1313–1322. https://doi.org/10.1001/jama.2014.12660

    Article  CAS  PubMed  Google Scholar 

  21. Hole J, Hirsch M, Ball E et al (2015) Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet 386(10004):1659. https://doi.org/10.1016/S0140-6736(15)60169-6 (Epub 2015 Aug 12)

    Article  PubMed  Google Scholar 

  22. Hurley M, Dickson K, Hallett R et al (2018) Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database Syst Rev CD010842(4). https://doi.org/10.1002/14651858.CD010842.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  23. Johnson M (2007) Transcutaneous electrical nerve stimulation: mechanisms, clinical application and evidence. Rev Pain 1(1):7–11. https://doi.org/10.1177/204946370700100103

    Article  PubMed  PubMed Central  Google Scholar 

  24. Johnson MI, Paley CA, Howe TE et al (2015) Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006142.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ju ZY, Wang K, Cui HS et al (2017) Acupuncture for neuropathic pain in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012057.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  26. Khadilkar A, Odebiyi DO, Brosseau L et al (2008) Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003008.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kroeling P, Gross A, Graham N et al (2013) Electrotherapy for neck pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004251.pub5

    Article  PubMed  Google Scholar 

  28. Kröner-Herwig B, Frettlöh J, Klinger R, Nilges P (2011) Schmerzpsychotherapie. Grundlagen – Diagnostik – Krankheitsbilder – Behandlung, 7. Aufl. Springer, Berlin, Heidelberg

    Google Scholar 

  29. Kuss K, Laekeman M (2016) Schmerzphysiotherapie, Physikalische Therapie und Trainingstherapie. In: Schuler M (Hrsg) Schmerztherapie beim älteren Patienten. De Gruyter, Berlin, S 307–375

    Google Scholar 

  30. Lane R, Harwood A, Watson L et al (2017) Exercise for intermittent claudication. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000990.pub4

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lee JH (2016) The Effects of Music on Pain: A Meta-Analysis. J Music Ther 53(4):430–477. https://doi.org/10.1093/jmt/thw012

    Article  PubMed  Google Scholar 

  32. Malanga GA, Yan N, Stark J (2015) Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med 127(1):57. https://doi.org/10.1080/00325481.2015.992719

    Article  PubMed  Google Scholar 

  33. Manheimer E, Cheng K, Wieland LS et al (2018) Acupuncture for hip osteoarthritis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD013010

    Article  PubMed  PubMed Central  Google Scholar 

  34. Manyanga T, Froese M, Zarychanski R et al (2014) Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. Bmc Complementary Altern Med 14:312. https://doi.org/10.1186/1472-6882-14-312

    Article  Google Scholar 

  35. O’Leary H, Smart KM, Moloney NA et al (2018) Pain sensitization associated with nonresponse after physiotherapy in people with knee osteoarthritis. Pain. https://doi.org/10.1097/j.pain.0000000000001288

    Article  PubMed  Google Scholar 

  36. Page CJ, Hinman RS, Bennell KL (2011) Physiotherapy management of knee osteoarthritis. Int J Rheum Dis 14:145–151. https://doi.org/10.1111/j.1756-185X.2011.01612.x

    Article  PubMed  Google Scholar 

  37. Page MJ, Green S, Mrocki MA et al (2016) Electrotherapy modalities for rotator cuff disease. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012225

    Article  PubMed  PubMed Central  Google Scholar 

  38. Paige NM, Miake-Lye IM, Booth MS et al (2017) Association of spinal manipulative therapy with clinical benefit and Harm for acute low back pain-systematic review and meta-analysis. JAMA 317(14):1451. https://doi.org/10.1001/jama.2017.3086

    Article  PubMed  PubMed Central  Google Scholar 

  39. Rubinstein SM, van Middelkoop M, Assendelft WJJ et al (2011) Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008112.pub2

    Article  PubMed  Google Scholar 

  40. Rubinstein SM, Terwee CB, Assendelft WJJ et al (2012) Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008880.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  41. Rutjes AWS, Nüesch E, Sterchi R et al (2009) Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002823.pub2

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Corinna Drebenstedt.

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C. Drebenstedt gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von der Autorin durchgeführten Studien an Menschen oder Tieren.

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Drebenstedt, C. Nichtmedikamentöse Schmerztherapie bei chronischem Schmerz. Z Gerontol Geriat 51, 859–864 (2018). https://doi.org/10.1007/s00391-018-01465-4

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  • DOI: https://doi.org/10.1007/s00391-018-01465-4

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