Download PDF
Psychother Psychosom Med Psychol 2019; 69(08): 313-322
DOI: 10.1055/a-0813-2086
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Therapie des chronischen Rückenschmerzes unter Berücksichtigung psychosozialer Faktoren

Therapy of Chronic Back Pain Considering Psychosocial Aspects
Lea Henn
1   Medizinische Psychologie und Medizinische Soziologie, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Mainz
,
Jochen Hardt
1   Medizinische Psychologie und Medizinische Soziologie, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Mainz
› Author Affiliations
Further Information

Publication History

eingereicht 16 August 2018

akzeptiert 07 November 2018

Publication Date:
14 January 2019 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Chronische Schmerzen, darunter v. a. Rückenschmerz als häufigste Lokalisation, zählen zu den bedeutsamsten medizinischen Leiden weltweit. Die Kosten für das Gesundheitssystem sind dabei erheblich. Zugleich sind die derzeit noch häufig angewendeten Therapieansätze, die oftmals aus einer alleinigen symptomatischen Behandlung bestehen, wenig erfolgversprechend. In 80–85% der Fälle lassen sich keine morphologischen Anhaltspunkte für eine mögliche Ätiologie finden, sodass in diesem Fall von „nicht-spezifischen“ Rückenschmerzen gesprochen wird. Insgesamt betrachtet lässt sich die Genese chronischer Rückenschmerzen am besten durch einen multifaktoriellen Entstehungsmechanismus erklären, in den eine Kombination aus biopsychosozialen, biographischen, neurobiologischen, genetischen und kognitiven Faktoren mit einbezogen wird. Aus diesem Grund zeigt eine multimodal ausgerichtete Therapie die beste Wirksamkeit, weil sie die verschiedenen Aspekte der Schmerzentstehung berücksichtigen kann.

Abstract

Chronic pain and especially back pain rank among the most meaningful medical conditions worldwide. This leads to extensive costs in medical care systems. In about 80–85% of cases there is no morphologic evidence for a possible pain etiology, hence such forms are called „non-specific back pain“. Therapies with a pure focus on symptomatic aspects are not effective to treat non-specific pain. The origin of chronic back pain can be best explained via a multi causal mechanism with a combination of bio-psycho-social, biographical, neurobiological, genetic, and cognitive factors. Since various aspects of the pain genesis have to be considered, multidisciplinary treatment shows much better results.

Schlüsselwörter

Rückenschmerz - Ätiologie - Somatoforme Schmerzstörung - Leitlinie - Multimodale Therapie

Key words

back pain - etiology - somatoform pain disorder - guideline - multimodal therapy
 

  • Literatur

  • 1 Neuhauser H, Ellert U, Ziese T. Chronic back pain in the general population in Germany 2002/2003: prevalence and highly affected population groups. Gesundheitswesen 2005; 67: 685-693
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Hoy D, Bain C, Williams G. et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012; 64: 2028-2037 doi:10.1002/art.34347
    CrossrefPubMedGoogle Scholar
  • 3 Hoy D, Brooks P, Blyth F. et al. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010; 24: 769-781 doi:10.1016/j.berh.2010.10.002
    CrossrefPubMedGoogle Scholar
  • 4 Paanalahti K, Holm LW, Magnusson C. et al. The sex-specific interrelationship between spinal pain and psychological distress across time in the general population. Results from the Stockholm Public Health Study. Spine J. 2014; 14: 1928-1935 doi:10.1016/j.spinee.2013
    CrossrefPubMedGoogle Scholar
  • 5 Jackson T, Thomas S, Stabile V. et al. Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2015; 385 (Suppl. 02) S10 doi:10.1016/S0140-6736(15)60805-4
    PubMedGoogle Scholar
  • 6 Schneider S, Schmitt H, Zoller S. et al. Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population. Int Arch Occup Environ Health 2005; 78: 253-269 doi:10.1007/s00420-004-0576-4
    CrossrefPubMedGoogle Scholar
  • 7 Unruh AM. Gender variations in clinical pain experience. Pain 1996; 65: 123-167
    CrossrefPubMedGoogle Scholar
  • 8 Tlach L, Hampel P. Gender differences in psychosocial variables in inpatient orthopedic rehabilitation of chronic low back pain. Psychother Psychosom Med Psychol 2010; 60: 417-424 doi:10.1055/s-0029-1214420
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Werber A, Schiltenwolf M. Chronic lower back pain. Nervenarzt 2012; 83: 243-257 quiz 258 doi:10.1007/s00115-011-3421-5
    CrossrefPubMedGoogle Scholar
  • 10 Wörz R. Psychosocial factors in chronic back pain. MMW Fortschr Med 2002; 144: 45-47
    PubMedGoogle Scholar
  • 11 Wenig CM, Schmidt CO, Kohlmann T. et al. Costs of back pain in Germany. Eur J Pain 2009; 13: 280-286
    CrossrefPubMedGoogle Scholar
  • 12 Bundesärztekammer (BÄK). Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuzschmerz – Langfassung, 2. Auflage. Version 1 Im Internet: http://www.leitlinien.de/mdb/downloads/nvl/kreuzschmerz/kreuzschmerz-2aufl-vers1-lang.pdf/@@download/file/kreuzschmerz-2aufl-vers1-lang.pdf Stand: 20.06.2018
    PubMed
  • 13 Müller-Schwefe G, Freytag A, Hoer A. et al. Healthcare utilization of back pain patients: results of a claims data analysis. J Med Econ 2011; 14: 816-823 doi:10.3111/13696998.2011.625067
    CrossrefPubMedGoogle Scholar
  • 14 Hildebrandt J. Does unspecific low back pain really exist?. Z Orthop Ihre Grenzgeb 2004; 142: 139-145 doi:10.1055/s-2004-822623
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Jenewein J. Back pain and somatisation. Ther Umsch 2013; 70: 537-541 doi:10.1024/0040-5930/a000443
    CrossrefPubMedGoogle Scholar
  • 16 Werber A, Schiltenwolf M. Treatment of Lower Back Pain – The Gap between Guideline-Based Treatment and Medical Care Reality. Healthcare (Basel) 2016; 4: 1-9 doi:10.3390/healthcare4030044
    CrossrefPubMedGoogle Scholar
  • 17 Power C, Frank J, Hertzman C. et al. Predictors of low back pain onset in a prospective British study. Am J Public Health 2001; 91: 1671-1678
    CrossrefPubMedGoogle Scholar
  • 18 Gureje O, Von Korff M, Simon GE. et al. Persistent pain and well-being: a World Health Organization Study in Primary Care. Jama 1998; 280: 147-151
    CrossrefPubMedGoogle Scholar
  • 19 Pincus T, Burton AK, Vogel S. et al. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 2002; 27: E109-E120
    CrossrefPubMedGoogle Scholar
  • 20 Linton SJ. A review of psychological risk factors in back and neck pain. Spine 2000; 25: 1148-1156
    CrossrefPubMedGoogle Scholar
  • 21 Vargas-Prada S, Coggon D. Psychological and psychosocial determinants of musculoskeletal pain and associated disability. Best Pract Res Clin Rheumatol 2015; 29: 374-390 doi:10.1016/j.berh.2015.03.003
    CrossrefPubMedGoogle Scholar
  • 22 Flothow A, Zeh A, Nienhaus A. Unspecific back pain – basic principles and possibilities for intervention from a psychological point of view. Gesundheitswesen 2009; 71: 845-856 doi:10.1055/s-0029-1192028
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Kohlmann T. Die Chronifizierung von Rückenschmerzen. Ergebnisse eines internationalen WHO-Workshops. Bundesgesundheitsblatt -Gesundheitsforschung -Gesundheitsschutz 2003; 46: 327-335
    CrossrefPubMedGoogle Scholar
  • 24 Borys C, Wisch S, Heim D. et al. Health care system utilization due to low back pain: sociodemographic, pain-related and psychosocial determinants. Psychother Psychosom Med Psychol 2013; 63: 280-285 doi:10.1055/s-0032-1327753
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Schmidt CO, Moock J, Fahland RA. et al. Back pain and social status among the working population: what is the association? Results from a German general population survey. Schmerz 2011; 25: 306-314 doi:10.1007/s00482-011-1050-3
    CrossrefPubMedGoogle Scholar
  • 26 Pfeifer AC, Ehrenthal JC, Neubauer E. et al. Impact of attachment behavior on chronic and somatoform pain. Schmerz 2016; 30: 444-456 doi:10.1007/s00482-016-0156-z
    CrossrefPubMedGoogle Scholar
  • 27 Dunn KM, Hestbaek L, Cassidy JD. Low back pain across the life course. Best Pract Res Clin Rheumatol 2013; 27: 591-600 doi:10.1016/j.berh.2013.09.007
    CrossrefPubMedGoogle Scholar
  • 28 Taylor JB, Goode AP, George SZ. et al. Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. Spine J 2014; 14: 2299-2319 doi:10.1016/j.spinee.2014.01.026
    CrossrefPubMedGoogle Scholar
  • 29 Engel GL. Psychogenic pain and pain-prone patient. Am J Med 1959; 26: 899-918
    CrossrefPubMedGoogle Scholar
  • 30 Rief W, Hiller W. Somatisierungsstörungen. 2. Aufl. Göttingen: Hogrefe; 2011
    Google Scholar
  • 31 Hiller W, Rief W, Brähler E. Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 704-712 doi:10.1007/s00127-006-0082-y
    CrossrefPubMedGoogle Scholar
  • 32 Bacon NM, Bacon SF, Atkinson JH. et al. Somatization symptoms in chronic low back pain patients. Psychosom Med 1994; 56: 118-127
    CrossrefPubMedGoogle Scholar
  • 33 Henn L. Kindheitsbelastungen und Eltern-Kind-Beziehung bei muskuloskelettalen Schmerzen [Dissertation]. Universitätsmedizin Mainz; 2018
    PubMed
  • 34 Reuchlein B, Henn L, Brian T. et al. Childhood Adversities and Adult Headache in Poland and Germany. PloS one 2016; 11: e0148162 doi:10.1371/journal.pone.0148162
    CrossrefPubMedGoogle Scholar
  • 35 Nickel R, Hardt J, Kappis B. et al. Somatoform disorders with pain as the predominant symptom: results to distinguish a common group of diseases. Schmerz 2009; 23: 392-398 doi:10.1007/s00482-009-0805-6
    CrossrefPubMedGoogle Scholar
  • 36 Hessel A, Beutel M, Geyer M. et al. Prevalence of somatoform pain complaints in the German population. Psychosoc Med 2005; 2 Doc03
    PubMedGoogle Scholar
  • 37 Egle UT, Nickel R. Chronic low back pain as a somatoform pain disorder. Orthopäde 2008; 37: 280-284 doi:10.1007/s00132-008-1224-6
    CrossrefPubMedGoogle Scholar
  • 38 Egle UT, Nickel R, Schwab R. et al. Die somatoforme Schmerzstörung. Dt Ärztebl. 2000; 97: 1469-1473
    PubMedGoogle Scholar
  • 39 Egle UT, Nickel R. Somatoforme Schmerzstörung. In: Kampfhammer HP, Gündel H. (Hrsg.) Psychotherapie der Somatisierungsstörungen: Krankheitsmodelle und Therapiepraxis – störungsspezifisch und schulenübergreifend. Stuttgart: Georg Thieme; 2001: 235-250
    Google Scholar
  • 40 Sauer N, Eich W. Somatoforme Störungen und Funktionsstörungen. Dt Ärztebl 2007; 104: 45-54
    PubMedGoogle Scholar
  • 41 World Health Organization . The ICD-10 classification of mental and behavioral disorders. Clinical descriptions and diagnostic guidelines. Geneva: 1994
    Google Scholar
  • 42 Dilling H, Freyberger HJ. ICD-10: Taschenführer zur ICD-10-Klassifikation psychischer Störungen. Göttingen: Hogrefe; 2016
    Google Scholar
  • 43 Rief W, Isaac M. The future of somatoform disorders: somatic symptom disorder, bodily distress disorder or functional syndromes?. Curr Opin Psychiatry 2014; 27: 315-319 doi:10.1097/YCO.0000000000000089
    CrossrefPubMedGoogle Scholar
  • 44 Rief W. Painting the picture of distressing somatic symptoms. J Psychosom Res 2010; 68: 1-3 doi:10.1016/j.jpsychores.2009.11.001
    CrossrefPubMedGoogle Scholar
  • 45 Sharpe M. Somatic symptoms: beyond ‘medically unexplained’. J Ment Sci 2013; 203: 320-321 doi:10.1192/bjp.bp.112.122523
    PubMedGoogle Scholar
  • 46 Gureje O, Reed GM. Bodily distress disorder in ICD-11: problems and prospects. World Psychiatry 2016; 15: 291-292 doi:10.1002/wps.20353
    CrossrefPubMedGoogle Scholar
  • 47 Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 2010; 68: 415-426 doi:10.1016/j.jpsychores.2010.02.004
    CrossrefPubMedGoogle Scholar
  • 48 Fink P, Toft T, Hansen MS. et al. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med 2007; 69: 30-39 doi:10.1097/PSY.0b013e31802e46eb
    CrossrefPubMedGoogle Scholar
  • 49 Falkai P, Wittchen HU. Diagnostisches und Statistisches Manual Psychischer Störungen – DSM-5. Göttingen: Hogrefe; 2015
    Google Scholar
  • 50 Toussaint A, Löwe B, Brähler E. et al. The Somatic Symptom Disorder – B Criteria Scale (SSD-12): Factorial structure, validity and population-based norms. J Psychosom Res 2017; 97: 9-17 dio:10.1016/j.jpsychores.2017.03.017
    CrossrefPubMedGoogle Scholar
  • 51 van der Feltz-Cornelis CM, van Houdenhove B. DSM-5: from ‘somatoform disorders’ to ‘somatic symptom and related disorders’. Tijdschr Psychiatr 2014; 56: 182-186
    PubMedGoogle Scholar
  • 52 Voigt K, Wollburg E, Weinmann N. et al. Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder – comparison with DSM-IV somatoform disorders and additional criteria for consideration. J Psychosom Res 2012; 73: 345-350 doi:10.1016/j.jpsychores.2012.08.020
    CrossrefPubMedGoogle Scholar
  • 53 Klaus K, Rief W, Brähler E. et al. The distinction between „medically unexplained“ and „medically explained“ in the context of somatoform disorders. Int J Behav Med 2013; 20: 161-171 doi:10.1007/s12529-012-9245-2
    CrossrefPubMedGoogle Scholar
  • 54 Katz J, Rosenbloom BN, Fashler S. Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Can J Psychiatry 2015; 60: 160-167 doi:10.1177/070674371506000402
    CrossrefPubMedGoogle Scholar
  • 55 Rief W, Martin A. How to use the new DSM-5 somatic symptom disorder diagnosis in research and practice: a critical evaluation and a proposal for modifications. Annu Rev Clin Psychol 2014; 10: 339-367 doi:10.1146/annurev-clinpsy-032813-153745
    CrossrefPubMedGoogle Scholar
  • 56 Egle UT, Franz M, Joraschky P. et al. Health-related long-term effects of adverse childhood experiences – an update. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2016; 59: 1247-1254 doi:10.1007/s00103-016-2421-9
    CrossrefPubMedGoogle Scholar
  • 57 Burke NN, Finn DP, McGuire BE. et al. Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms. J Neurosci Res 2017; 95: 1257-1270 doi:10.1002/jnr.23802
    CrossrefPubMedGoogle Scholar
  • 58 McGowan PO, Sasaki A, D’Alessio AC. et al. Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nat Neurosci 2009; 12: 342-348 doi:10.1038/nn.2270
    Google Scholar
  • 59 Rief W, Barsky AJ. Psychobiological perspectives on somatoform disorders. Psychoneuroendocrinology 2005; 30: 996-1002 doi:10.1016/j.psyneuen.2005.03.018
    CrossrefPubMedGoogle Scholar
  • 60 Overfeld J, Heim C. Psychobiologische Folgen früher Stresserfahrungen. In: Egle UT, Joraschky P, Lampe A. et al. (Hrsg.) Sexueller Missbrauch, Misshandlung,Vernachlässigung. 4. Aufl. Stuttgart: Schattauer-Verlag; 2016
    Google Scholar
  • 61 Lahmann C, Henningsen P, Noll-Hussong M. Somatoform pain disorder - overview. Psychiatr Danub 2010; 22: 453-458
    PubMedGoogle Scholar
  • 62 Egle UT. Stressinduzierte Hyperalgesie (SIH) als Folge von emotionaler Deprivation und psychischer Traumatisierung in der Kindheit. In: Egle UT, Joraschky P, Lampe A. et al. (Hrsg.) Sexueller Missbrauch, Misshandlung,Vernachlässigung. 4. Aufl. Stuttgart: Schattauer; 2016: 411-425
    Google Scholar
  • 63 Vachon-Presseau E, Roy M, Martel MO. et al. The stress model of chronic pain: evidence from basal cortisol and hippocampal structure and function in humans. Brain 2013; 136: 815-827 doi:10.1093/brain/aws371
    CrossrefPubMedGoogle Scholar
  • 64 Egle UT, Egloff N, von Kanel R. Stress-induced hyperalgesia (SIH) as a consequence of emotional deprivation and psychosocial traumatization in childhood : Implications for the treatment of chronic pain. Schmerz 2016; 30: 526-536 doi:10.1007/s00482-016-0107-8
    CrossrefPubMedGoogle Scholar
  • 65 Vachon-Presseau E, Centeno MV, Ren W. et al. The Emotional Brain as a Predictor and Amplifier of Chronic Pain. J Dent Res 2016; 95: 605-612 doi:10.1177/0022034516638027
    CrossrefPubMedGoogle Scholar
  • 66 Vachon-Presseau E, Tetreault P, Petre B. et al. Corticolimbic anatomical characteristics predetermine risk for chronic pain. Brain 2016; 139: 1958-1970 doi:10.1093/brain/aww100
    CrossrefPubMedGoogle Scholar
  • 67 Ferreira PH, Beckenkamp P, Maher CG. et al. Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples. Eur J Pain 2013; 17: 957-971 doi:10.1002/j.1532-2149.2012.00277.x
    CrossrefPubMedGoogle Scholar
  • 68 Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc 2015; 126: 167-183
    PubMedGoogle Scholar
  • 69 Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191-215
    CrossrefPubMedGoogle Scholar
  • 70 Costa Lda C, Maher CG, McAuley JH. et al. Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. Eur J Pain 2011; 15: 213-219 doi:10.1016/j.ejpain.2010.06.014
    CrossrefPubMedGoogle Scholar
  • 71 Turner JA, Jensen MP, Romano JM. Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain?. Pain 2000; 85: 115-125
    CrossrefPubMedGoogle Scholar
  • 72 Tan G, Teo I, Anderson KO. et al. Adaptive versus maladaptive coping and beliefs and their relation to chronic pain adjustment. Clin J Pain 2011; 27: 769-774 doi:10.1097/AJP.0b013e31821d8f5a
    CrossrefPubMedGoogle Scholar
  • 73 Scholich SL, Hallner D, Wittenberg RH. et al. The relationship between pain, disability, quality of life and cognitive-behavioural factors in chronic back pain. Disabil Rehabil 2012; 34: 1993-2000 doi:10.3109/09638288.2012.667187
    CrossrefPubMedGoogle Scholar
  • 74 Ong AD, Zautra AJ, Reid MC. Psychological resilience predicts decreases in pain catastrophizing through positive emotions. Psychol Aging 2010; 25: 516-523 doi:10.1037/a0019384
    CrossrefPubMedGoogle Scholar
  • 75 Stenberg G, Fjellman-Wiklund A, Ahlgren C. ‘I am afraid to make the damage worse’ – fear of engaging in physical activity among patients with neck or back pain – a gender perspective. Scand J Caring Sci 2014; 28: 146-154 doi:10.1111/scs.12043
    CrossrefPubMedGoogle Scholar
  • 76 Juniper M, Le TK, Mladsi D. The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother 2009; 10: 2581-2592
    CrossrefPubMedGoogle Scholar
  • 77 Airaksinen O, Brox JI, Cedraschi C. et al. Chapter 4: European guidelines for the management of chronic non-specific low back pain. European Spine Journal 2006; 15: S192-S300
    CrossrefPubMedGoogle Scholar
  • 78 Koes BW, van Tulder M, Lin CW. et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal 2010; 19: 2075-2094 doi:10.1007/s00586-010-1502-y
    CrossrefPubMedGoogle Scholar
  • 79 BfArM. Flupirtin: Schwerwiegende Leberschäden. Im Internet: https://www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RV_STP/a-f/flupirtin-10-2017.html Stand 1.12.2018
    PubMed
  • 80 Deutsche Schmerzgesellschaft. Empfehlungen der S3 – Leitlinie „Langzeitanwendung von Opioiden bei nicht tumorbedingten Schmerzen – „LONTS““ Im Internet: http://www.awmf.org/uploads/tx_szleitlinien/145-003l_S3_LONTS_2015-01.pdf; Stand: 20.06.2018.
    PubMed
  • 81 Dietl M, Korczak D. Over-, under- and misuse of pain treatment in Germany. GMS Health Technol Assess 2011; 7 Doc03 DOI: 10.3205/hta000094.
    CrossrefPubMedGoogle Scholar
  • 82 Werber A, Marschall U, L’Hoest H. et al. Opioid therapy in the treatment of chronic pain conditions in Germany. Pain Physician 2015; 18: E323-E331
    PubMedGoogle Scholar
  • 83 Nickel R, Leweke F, Egle UT. Curriculum psychosomatic pain therapy. Psychother Psychosom Med Psychol 2012; 62: 242-243 doi:10.1055/s-0032-1305021
    Article in Thieme ConnectPubMedGoogle Scholar
  • 84 Thomson S. Failed back surgery syndrome – definition, epidemiology and demographics. Br J Pain 2013; 7: 56-59 doi:10.1177/2049463713479096
    CrossrefPubMedGoogle Scholar
  • 85 Casser HR. Multimodal therapy concepts for failed back surgery syndrome. Orthopäde 2016; 45: 723-731 doi:10.1007/s00132-016-3307-0
    CrossrefPubMedGoogle Scholar
  • 86 Cho JH, Lee JH, Song KS. et al. Treatment Outcomes for Patients with Failed Back Surgery. Pain physician 2017; 20: E29-E43
    PubMedGoogle Scholar
  • 87 Wertli MM, Steurer J. Pain medications for acute and chronic low back pain. Internist 2018; 59: 1214-1223 doi:10.1007/s00108-018-0475-5
    CrossrefPubMedGoogle Scholar
  • 88 Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet 2011; 377: 2226-2235
    CrossrefPubMedGoogle Scholar
  • 89 Machado LA, Kamper SJ, Herbert RD. et al. Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology (Oxford) 2009; 48: 520-527 doi:10.1093/rheumatology/ken470
    CrossrefPubMedGoogle Scholar
  • 90 Ivanova JI, Birnbaum HG, Schiller M. et al. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. Spine J 2011; 11: 622-632
    CrossrefPubMedGoogle Scholar
  • 91 Nagel B, Korb J. Interdisciplinary treatment. Long-lasting, effective, and cost-effective. Orthopäde 2009; 38: 907-908 910–912 doi:10.1007/s00132-009-1482-y
    CrossrefPubMedGoogle Scholar
  • 92 Hildebrandt J, Pfingsten M. Chronischer Rückenschmerz. In: Egle UT, Hoffmann SO, Lehmann KA. et al. (Hrsg.) Handbuch Chronischer Schmerz. Stuttgart: Schattauer; 2003: 505-517
    Google Scholar
  • 93 Behrendt S, Kulas H, Marschall U. et al. Which Back Pain Patients Benefit From Multidisciplinary Pain Management? A Comparative Cost Analysis Using Claims Data of Statutory Health Insurance. Gesundheitswesen 2016; 78: e120-e127 doi:10.1055/s-0042-110401
    Article in Thieme ConnectPubMedGoogle Scholar
  • 94 Loeser JD, Cahana A. Pain medicine versus pain management: ethical dilemmas created by contemporary medicine and business. Clin J Pain 2013; 29: 311-316 doi:10.1097/AJP.0b013e3182516e64
    CrossrefPubMedGoogle Scholar
  • 95 Richmond H, Hall AM, Copsey B. et al. The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. PloS one 2015; 10: e0134192 doi:10.1371/journal.pone.0134192
    CrossrefPubMedGoogle Scholar
  • 96 Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2012; 11: CD007407 doi:10.1002/14651858.CD007407.pub3
    CrossrefPubMedGoogle Scholar
  • 97 Henningsen P. The psychosomatics of chronic back pain. Classification, aetiology and therapy. Orthopäde 2004; 33: 558-567 doi:10.1007/s00132-003-0615-y
    CrossrefPubMedGoogle Scholar
  • 98 Bandemer-Greulich U, Bosse B, Fikentscher E. et al. Efficacy of psychological interventions on pain coping strategies in orthopedic rehabilitation of chronic low back pain. Psychother Psychosom Med Psychol 2008; 58: 32-37 doi:10.1055/s-2007-970999
    Article in Thieme ConnectPubMedGoogle Scholar
  • 99 Kaiser U, Sabatowski R, Azad SC. Multimodal pain therapy. Current situation. Schmerz 2015; 29: 550-556 doi:10.1007/s00482-015-0030-4
    PubMedGoogle Scholar
  • 100 Deckert S, Kaiser U, Kopkow C. et al. A systematic review of the outcomes reported in multimodal pain therapy for chronic pain. Eur J Pain 2016; 20: 51-63 doi:10.1002/ejp.721
    CrossrefPubMedGoogle Scholar