Dtsch Med Wochenschr 2022; 147(07): 379-389
DOI: 10.1055/a-1581-5510

Kreuzschmerzen aus hausärztlicher-internistischer Sicht

Nicht spezifische und spezifische untere RückenschmerzenLower back pain in the primary care settingNon-specific and specific pain
Dieter Burchert
Christine Schwill

Kreuzschmerzen sind weltweit die führende Ursache für körperliche Beeinträchtigungen. In über 80 % der Fälle finden sich keine organischen Ursachen. Bei 20 % gilt es, eine spezifische Ursache frühzeitig zu erkennen, um potenziell gefährliche oder entsprechend therapierbare Verläufe abzuwenden. Entscheidende Hinweise zur Ätiologie liefert eine gründliche Anamnese, die oftmals durch die körperliche Untersuchung nur ergänzend bestätigt wird.


A systematic survey of the symptoms of back pain in terms of triggering event and onset, nature and the extent of influenceability of the pain (lying or standing, under stress, nocturnal pain, localized percussion tenderness, B- symptoms, etc.), as well as structured clinical examination (segment height, radiance, projection, reflex status, sensitivity and motor function) allows an initial and therefore orienting classification of back pain as non-specific or specific. In the primary care setting many patients can be treated extremely effectively and economically from a cost perspective. In addition to the fastest possible pain relief, it is important to prevent the disease becoming chronic. A wide range of pharmacological treatment can be combined with non-pharmacological measures, such as early on exercises, promoting every day mobility, physiotherapy, manual therapy etc.. 20 % of patients with lower back pain have a determinable cause that needs to be rapidly identified. In addition to laboratory diagnostics, structured morphological imaging is necessary. Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis as well as extravertebral causes. In the further cause of treatment, it may be necessary to consult medical specialists in the fields of radiology, orthopedics, neurology, neurosurgery, rheumatology, psychotherapy, psychiatry, among others. Treatment is managed by the primary care provider, who should also receive and re-evaluate all findings during the course of the disease.

Publication History

Article published online:
28 March 2022

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