Schmerz ist nicht gleich Schmerz – Schmerzmechanismen im Clinical Reasoning identifizieren

Oft verbirgt sich hinter ärztlichen Diagnosen wie „Ischialgie“ oder „Dorsalgie“ ein komplexes Schmerzgeschehen. Für eine effektive Physiotherapie ist entscheidend, welcher Schmerzmechanimus überwiegt: nozizeptiv, neuropathisch, noziplastisch oder eine Mischform. Zwei praxisbewährte Grading-Systeme geben Orientierung bei der Beantwortung dieser Frage. Ein Fallbeispiel zeigt deren strukturierte Anwendung in der Praxis.

Publikationsverlauf

Artikel online veröffentlicht:
18. September 2025

• Literaturverzeichnis

• 1 Higgs J, Jensen GM, Loftus S. et al Clinical reasoning in the health professions. 4. Aufl. Chatswood: Elsevier; 2019
• 2 Jones MA, Rivett DA.. Clinical reasoning in musculoskeletal practice. 2. Aufl. Edinburgh;. New York: Elsevier; 2019
• 3 Luomajoki H, Schesser R.. Schmerzmechanismen und Clinical Reasoning. MSK – Muskuloskelettale Physiother 2022; 26: 43-58
• 4 Smart K, Doody C.. The clinical reasoning of pain by experienced musculoskeletal physiotherapists. Man Ther 2007; 12: 40-49
• 5 Schmid AB, Tampin B, Baron R. et al Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group. Pain 2023; 164: 1693-1704
• 6 Kosek E, Clauw D, Nijs J. et al Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain 2021; 162: 2629-2634
• 7 Nijs J, Kosek E, Chiarotto A. et al Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium’s international and multidisciplinary consensus recommendations. Lancet Rheumatol 2024; 6: e178-e188
• 8 Klute M, Laekeman M, Kuss K. et al Cross-cultural adaptation and validation of the German Central Sensitization Inventory (CSI-GE) BMC Musculoskelet Disord. 2021 22.
• 9 Rusu AC, Kreddig N, Hallner D. et al Fear of movement/(Re)injury in low back pain: confirmatory validation of a German version of the Tampa Scale for Kinesiophobia BMC Musculoskelet Disord. 2014; 15.
• 10 Meyer K, Sprott H, Mannion AF.. Cross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale. J Psychosom Res 2008; 64: 469-478
• 11 Bron C, Dommerholt J, Stegenga B. et al High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain BMC Musculoskelet Disord. 2011; 12.
• 12 Cloward RB.. Cervical Diskography. A Contribution to the Etiology and Mechanism of Neck, Shoulder and Arm Pain. Ann Surg 1959; 150: 1052-1064
• 13 Fukui S, Ohseto K, Shiotani M. et al Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain 1996; 68: 79-83
• 14 Mb AD, Aprill C, Bogduk N.. Cervical Zygapophyseal Joint Pain Patterns I: A Study in Normal Volunteers. Spine 1990; 15: 453-457
• 15 Slipman CW, Plastaras C, Patel R. et al Provocative cervical discography symptom mapping. Spine J 2005; 5: 381-388
• 16 Bogduk N.. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain 2009; 147: 17-19
• 17 Nijs J, Torres-Cueco R, van Wilgen CP. et al Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Pain Physician 2014; 17: 447-457
• 18 Nijs J, Mairesse O, Neu D. et al Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Phys Ther 2018; 98: 325-335
• 19 Jensen TS, Baron R, Haanpää M. et al A new definition of neuropathic pain. Pain 2011; 152: 2204-2205
• 20 Terminology | International Association for the Study of Pain. Int Assoc Study Pain IASP. Zugriff am 10.10.2023 unter:. https://www.iasp-pain.org/resources/terminology/
• 21 Treede R-D, Jensen TS, Campbell JN. et al Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology 2008; 70: 1630-1635
• 22 Finnerup NB, Haroutounian S, Kamerman P. et al Neuropathic pain: an updated grading system for research and clinical practice. Pain 2016; 157: 1599-1606
• 23 Nijs J, Mairesse O, Neu D. et al Sleep Disturbances in Chronic Pain: Neurobiology, Assessment, and Treatment in Physical Therapist Practice. Phys Ther 2018; 98: 325-335
• 24 Shraim MA, Sluka KA, Sterling M. et al Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study. Pain 2022; 163: 1812-1828
• 25 Nijs J, Torres-Cueco R, van Wilgen CP. et al Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain. Pain Physician 2014; 17: 447-457
• 26 Mayer TG, Neblett R, Cohen H. et al The development and psychometric validation of the central sensitization inventory. Pain Pract Off J World Inst Pain 2012; 12: 276-285
• 27 Nijs J, Malfliet A, Nishigami T.. Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians. Braz J Phys Ther 2023; 27: 100518
• 28 Maxwell S, Sterling M.. An investigation of the use of a numeric pain rating scale with ice application to the neck to determine cold hyperalgesia. Man Ther 2013; 18: 172-174
• 29 Fillingim RB, Loeser JD, Baron R. et al Assessment of Chronic Pain: Domains, Methods, and Mechanisms. J Pain 2016; 17: T10-20
• 30 Magerl W, Krumova EK, Baron R. et al Reference data for quantitative sensory testing (QST): refined stratification for age and a novel method for statistical comparison of group data. Pain 2010; 151: 598-605
• 31 Nijs J, Paul van Wilgen C, Van Oosterwijck J. et al How to explain central sensitization to patients with „unexplained” chronic musculoskeletal pain: practice guidelines. Man Ther 2011; 16: 413-418
• 32 Malfliet A, De Baets L, Bilterys T. et al Cognitive Behavioral Therapy for Insomnia in Pain Management for Nonspecific Chronic Spinal Pain: A Randomized Clinical Trial. JAMA Netw Open 2024; 7: e2425856
• 33 Butler DS, Moseley LG. Sunyata. Schmerzen verstehen. Berlin,. Heidelberg: Springer; 2016
• 34 Louw A, Zimney K, O’Hotto C. et al The clinical application of teaching people about pain. Physiother Theory Pract 2016; 32: 385-395
• 35 Nijs J, Leysen L, Vanlauwe J. et al Treatment of central sensitization in patients with chronic pain: time for change?. Expert Opin Pharmacother 2019; 20: 1961-1970
• 36 O’Sullivan PB, Caneiro JP, O’Keeffe M. et al Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Phys Ther 2018; 98: 408-423
• 37 Pandey SS, Ashish A, Singh R.. Physiotherapeutic Intervention for Cervicobrachial Pain Syndrome: A Scoping Review. Journal of Clinical and Diagnostic Research 2021; 15: YE01-YE06