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Multimodale Therapieprogramme für chronische Schmerzen

Multimodal therapy programs for chronic pain

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Zusammenfassung

Chronischer Schmerz hat erhebliche Auswirkungen auf die Lebensqualität der Patienten und führt zu einer hohen finanziellen Belastung des Gesundheitssystems. Unterschiedlichste konservative, interventionelle und operative Therapieansätze werden in der Praxis verwendet. Während hinsichtlich multimodaler Therapieansätze weiterhin eine Unterversorgung besteht, gibt es für monomodale pharmakologische und operativ-invasive Therapieansätze eine Überversorgung. Zunehmend werden in den letzten 2 Dekaden multimodale Therapieprogramme zur Behandlung chronischer Schmerzen durchgeführt und untersucht. In der wissenschaftlichen Literatur gibt es inzwischen ausreichende Evidenz, um multimodale und multidisziplinäre Therapieansätze als Behandlung der Wahl anzusehen. Die Verfügbarkeit und das Wissen um die richtige Komposition multimodaler Therapieprogramme sind jedoch noch insuffizient. Die Entstehung und Charakteristiken chronischer Schmerzen, die notwendige Patientenauswahl und verschiedene Therapieprogramme v. a. in Deutschland werden beschrieben.

Abstract

Chronic pain is a common and disabling disorder with major consequences for patient quality of life and it is also a major economic burden to society. The management of chronic pain comprises a large range of different intervention strategies including pharmacological therapy, non-medicinal and invasive therapeutic options. While non-pharmacological and multimodal options are underused, monomodal options, especially pharmacotherapy and invasive therapies are overused. The effectiveness of multidisciplinary and multimodal treatment programs including physical and rehabilitation interventions and psychological treatment has been extensively studied in the last two decades. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy alone, there is some evidence for the effectiveness of behavioral therapy and there is at least moderate evidence for the effectiveness of multidisciplinary and multimodal treatment and other active treatment reducing pain and increasing functional capacity at short and intermediate term. Therefore, blanket coverage with provision of adequate treatment programs for chronic pain as well as studies evaluating the best composition of treatment elements are needed. The characteristics of chronic pain, the necessary assessment procedures and treatment types are described.

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Einhaltung ethischer Richtlinien

Interessenskonflikt. E. Gjon gibt an, dass kein Interessenkonflikt besteht. A. Kopf: Beratungs- und Referententätigkeiten: Grünenthal, Astellas, Pfizer, Mundipharma, Mundipharma International, Janssen-Cilag, Abbott, Amgen, Nycomed, Kade, Boehringer Ingelheim. Drittmittel: Pfizer, Janssen-Cilag. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Kopf, A., Gjoni, E. Multimodale Therapieprogramme für chronische Schmerzen. Anaesthesist 64, 95–107 (2015). https://doi.org/10.1007/s00101-014-2418-4

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  • DOI: https://doi.org/10.1007/s00101-014-2418-4

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