Psychosomatik in der Schmerztherapie – Herausforderungen chronischer Schmerzen

Obwohl die Aufmerksamkeit unter den Ärztinnen und Ärzten in Bezug auf chronische Schmerzen wächst, gilt der Patient mit chronischen Schmerzen in der Praxis oftmals als komplexer, wenn nicht sogar „schwieriger“ Patient. Patienten mit chronischen Schmerzen sind damit dem erhöhten Risiko ausgesetzt, vorschnell abgewiesen und weitergeschickt zu werden. Gleichzeitig sind die therapeutischen Möglichkeiten oftmals begrenzt und die Therapieerfolge unbefriedigend.

Abstract

Although there is growing awareness among physicians regarding chronic pain, the patient with chronic pain is often considered a complex, if not “difficult” patient in practice. Patients with chronic pain are thus at increased risk of being hastily dismissed and sent on their way. At the same time, therapeutic options are often limited and therapeutic successes not satisfying.

Schlüsselwörter

Psychosmoatik - Schmerztherapie - chronische Schmerzen

Key words

Psychosmoatics - pain therapy - chronic pain

Publication History

Article published online:
10 June 2022

• Literatur

• 1 European Pain Federation . Pain Proposal: Improving the Current and Future Management of Chronic Pain. A European Consensus Report. Available at: https://europeanpainfederation.eu/wp-content/uploads/2016/06/pain_proposal.pdf Accessed: January 2021
• 2 Tesarz J. Psychosomatik in der Schmerztherapie. In: Seidler GH, Tesarz J, Streeck-Fischer A. Komplexe Krisen und Störungen. Stuttgart: Klett-Cotta; 2018
• 3 GBD 2016. Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211-1259 Erratum in: Lancet 2017; 390 (10106): e38 DOI: 10.1016/S0140-6736(17)32154-2.
• 4 Kosek E, Cohen M, Baron R. et al. Do we need a third mechanistic descriptor for chronic pain states?. Pain 2016; 157: 1382-1386 DOI: 10.1097/j.pain.0000000000000507.
• 5 Fitzcharles MA, Cohen SP, Clauw DJ.. et al. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet 2021; 397: 2098-2110 DOI: 10.1016/S0140-6736. (21)00392-5
• 6 Fishbain DA, Pulikal A, Lewis JE.. et al. Chronic pain types differ in their reported prevalence of post-traumatic stress disorder (PTSD) and there is consistent evidence that chronic pain is associated with PTSD: an evidence-based structured systematic review. Pain Med 2017; 18: 711-735 DOI: 10.1093/pm/pnw065.
• 7 Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019; 123: e273-e283 DOI: 10.1016/j.bja.2019.03.023.
• 8 Whibley D, AlKandari N, Kristensen K. et al. Sleep and Pain: A systematic review of studies of mediation. Clin J Pain 2019; 35: 544-558 DOI: 10.1097/AJP.0000000000000697.
• 9 Spitzer RL, Kroenke K, Williams JB. et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Int Med 2006; 166: 1092-1097 DOI: 10.1001/archinte. 166.10.1092.
• 10 Whooley MA, Avins AL, Miranda J. et al. Case-finding instruments for depression. Two questions are as good as many. J Gen Int Med 1997; 12: 439-445 DOI: 10.1046/j.1525-1497.1997.00076.x.
• 11 Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA 1984; 252: 1905-1907 DOI: 10.1001/jama. 252.14.1905.
• 12 Breslau N, Peterson EL, Kessler RC. et al. Short screening scale for DSM-IV posttraumatic stress disorder. Am J Psy 1999; 156: 908-911 DOI: 10.1176/ajp.156.6.908.
• 13 Becker A, Becker M, Engeser P. S1-Leitlinie: Chronischer Schmerz. AWMF-Leitlinien-Registernummer: 053/036; 2013 http://www.awmf.org/uploads/tx_szleitlinien/053-036l_S1_Chronischer_Schmerz_2013-10-abgelaufen.pdf Stand: 10.09.2021
• 14 Treede RD, Rief W, Barke A. et al. Chronic pain as a symptom or a disease: the IASP Classification of chronic pain for the International Classification of Diseases (ICD-11). Pain 2019; 160: 19-27 DOI: 10.1097/j.pain.0000000000001384.
• 15 Galvez-Sánchez CM, Reyes Del Paso GA. Diagnostic criteria for Fibromyalgia: Critical review and future perspectives. J Clin Med 2020; 9: 1219 DOI: 10.3390/jcm9041219.
• 16 Sliwinski J, Elkins GR. Enhancing placebo effects: Insights from social psychology. Am J Clin Hypn 2013; 55: 236-248 DOI: 10.1080/00029157.2012.740434.
• 17 Tesarz J, Eich W. Schmerz aus medizinpsychologischer Perspektive. In: Koch U, Bengel J (Hrsg.) Enzyklopädie der Psychologie – Medizinische Psychologie Band 2: Anwendungen. Göttingen: Hogrefe; 2016
• 18 Häuser W. 2.Aktualisierung der S3-Leitlinie Langzeitanwendungen von Opioiden bei chronischen nicht-tumorbedingten Schmerzen „LONTS“. Schmerz 2020; 34: 204-244 DOI: 10.1007/s00482-020-00472-y.
• 19 Suh JH, Kim H, Jung GP. et al. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine (Baltimore) 2019; 98: e16173 DOI: 10.1097/MD.0000000000016173.
• 20 Novo Navarro P, Landin-Romero R, Guardiola-Wanden-Berghe R. et al. 25 years of Eye Movement Desensitization and Reprocessing (EMDR): The EMDR therapy protocol, hypotheses of its mechanism of action and a systematic review of its efficacy in the treatment of post-traumatic stress disorder. Rev Psiquiatr Salud Ment (Engl Ed) 2018; 11: 101-114 DOI: 10.1016/j.rpsm.2015.12.002.
• 21 Gerhardt A, Leisner S, Hartmann M. et al. Eye Movement Desensitization and Reprocessing vs. treatment-as-usual for non-specific chronic back pain patients with psychological trauma: A randomized controlled pilot study. Front Psy 2016; 7: 201 DOI: 10.3389/fpsyt.2016.00201.
• 22 Maroufi M, Zamani S, Izadikhah Z. et al. Investigating the effect of Eye Movement Desensitization and Reprocessing (EMDR) on postoperative pain intensity in adolescents undergoing surgery: a randomized controlled trial. J Adv Nurs 2016; 72: 2207-2217 DOI: 10.1111/jan.12985.
• 23 Estergard L. Eye movement desensitization and reprocessing in the treatment of chronic pain. Walden: Walden University; 2009
• 24 Lumley M, Schubiner H, Lockhart N. et al. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain 2017; 158: 2354-2363 DOI: 10.1097/j. pain.0000000000001036.