Diagnostik und konservative Therapie von lumbalen Rückenschmerzen

Rückenschmerzen sind in allen Industrienationen eine der häufigsten Ursachen von Schmerzen, Arztbesuchen, diagnostischen und therapeutischen Maßnahmen, Krankschreibungen und Frühberentungen und damit auch sozioökonomischer Folgen. Die Ursachen sind vielfältig und oftmals nicht eindeutig zuzuordnen, die Folgen reichen von „harmlosen“ und zeitlich begrenzten Schmerzen mit hoher Spontanheilungsrate bis hin zu chronisch verlaufenden oder aber auch intermittierenden erheblichen Schmerzen und damit einhergehenden Funktionseinschränkungen und Verlust an Lebensqualität.

Im diesem Beitrag werden die Diagnostik und die konservative Therapie des nichtspezifischen Rückenschmerzes der Lendenwirbelsäule dargestellt.

• Literatur

• 1 Airaksinen O, Hildebrandt J, Mannion AF et al. European guidelines for the management of chronic nonspecific low back pain. European Commission Research Directorate General; 2004
• 2 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Kreuzschmerz – Langfassung Version 1.2 vom 25. August 2011. Im Internet: http://www.VersorgungsLeitlinien.de/themen/kreuzschmerz Stand: 26.08.2013
• 3 Casserley-Feeney SN, Daly L, Hurley DA. The access randomized clinical trial of public versus private physiotherapy for low back pain. Spine (Phila Pa 1976) 2012; 37: 85-96
• 4 Chou R, Qaseem A, Snow V et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147: 478-491
• 5 Chou R, Baisden J, Carragee EJ et al. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976) 2009; a 34: 1094-1109
• 6 Chou R, Fu R, Carrino JA et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 2009; b 373: 463-472
• 7 Chou R, Loeser JD, Owens DK et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976) 2009; c 34: 1066-1077
• 8 Croft PR, Macfarlane GJ, Papageorgiou AC et al. Outcome of low back pain in general practice: a prospective study. BMJ 1998; 316: 1356
• 9 Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med 1988; 3: 230-238
• 10 Deyo RA, Rainville J, Kent DL et al. What can the history and physical examination tell us about low back pain?. JAMA 1992; 268: 760
• 11 Freiburger JK, Holmes GM, Agans RP et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169: 251
• 12 French SD, Cameron M, Walker BF et al. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976) 2006; 31: 998-1006
• 13 Furlan AD, Imamura M, Dryden T et al. Massage for low back pain: an updated systematic review within the framework of the Cochrane Back Review Group. Spine (Phila Pa 1976) 2009; 34: 1669-1684
• 14 Gellhorn AC, Chan L, Martin B et al. Management patterns in acute low back pain: the role of physical therapy. Spine (Phila Pa 1976) 2012; 37: 775-782
• 15 Gilbert FJ, Grant AM, Gillan MG et al. Low back pain: influence of early MR imaging or CT on treatment and outcome – multicenter randomized trial. Radiology 2004; 231: 343-351
• 16 Henschke N, Maher CG, Refshauge KM et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008; 337: a171
• 17 Imhof H. Imaging of spinal Injuries. In: Marincek B, Dondelinger RF, eds. Emergency Radiology. Imaging and Intervention. Berlin: Springer; 2007: 141-153
• 18 Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 2002; 137: 586-597
• 19 Jarvik JJ, Hollingworth W, Heagerty P et al. The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine ( Phila Pa 1976) 2001; 26: 1158-1166
• 20 Jarvik JG, Hollingworth W, Martin B et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA 2003; 289: 2810-2818
• 21 Jensen MC, Brant-Zawadzki MN, Obuchowski N et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331: 69-73
• 22 Katz JN. Lumbar disc disorders and low-back pain: sozioeconomic factors and consequences. J Bone Joint Surg Am 2006; 88 Suppl 2: 21
• 23 Kendrick D, Fielding K, Bentley E et al. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ 2001; 322: 400-405
• 24 Khadilkar A, Odebiyi DO, Brosseau L et al. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev 2008; (4) CD003008
• 25 Koes BW, Tulder MW van Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332: 1430-1434
• 26 Kohlmann T, Raspe H. Der Funktionsfragebogen Hannover zur alltagsnahen Diagnostik der Funktionsbeeinträchtigung durch Rückenschmerzen (FFbH-R). Rehabilitation 1996; 35: I-VIII
• 27 Kohlmann T, Deck R, Klockgether R et al. Rückenschmerzen in der Lübecker Bevölkerung: Syndrome, Krankheitsverhalten und Versorgung. Z Rheumatol 1998; 57: 238-240
• 28 Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine (Phila Pa 1976) 2008; 33: 2464-2472
• 29 Lamb SE, Hansen Z, Lall R et al. Group cognitive behavioural treatment for low-back pain in primary care: a randomized controlled trial and cost-effectiveness analysis. Lancet 2010; 375: 916-923
• 30 Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine (Phila Pa 1976) 2003; 28: 616-620
• 31 Matsudaira K, Konishi H, Miyoshi K et al. Potential risk factors for new onset of back pain disability in Japanese workers: Findings from the Japan epidemiological research of occupation-related back pain study. Spine (Phila Pa 1976) 2012; 37: 1324-1333
• 32 Muller R, Giles LG. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther 2005; 28: 3-11
• 33 Myers SS, Phillips RS, Kaptchuk TJ et al. Patient expectations as predictors of outcome in patients with acute low back pain. J Gen Intern Med 2008; 23: 148-153
• 34 Ostelo RW, van Tulder MW, Vlaeyen JW et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 2005; (1) CD002014
• 35 Raspe H. Back Pain. In: Silman AJ, Hochberg MC, eds. Epidemiology of the Rheumatic Diseases. 2nd. ed. Oxford: Oxford University Press; 2001: 309-338
• 36 Robert Koch-Institut – RKI. Gesundheit in Deutschland. Berlin: RKI 2006. Im Internet: http://www.gbe-bund.de/gbe10/trecherche.prc_them_rech?tk=2008&tk2=240&p_uid=gast&p_aid=58690113&p_sprache=D&cnt_ut=1&ut=240 Stand: 09.09.2009
• 37 Rudwaleit M, Märker-Herrmann E. Management des nichtspezifischen Kreuzschmerzes. Z Rheumatol 2012; 71: 485-500
• 38 Rudwaleit M, van der Heijde D, Khan MA et al. How to diagnose axial spondyloarthritis early. Ann Rheum Dis 2004; 63: 535-543
• 39 Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria?. Arthritis Rheum 2005; 52: 1000-1008
• 40 Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J 2006; 6: 131-137
• 41 Schmidt CO, Kohlmann T. Was wissen wir über das Symptom Rückenschmerz? Epidemiologische Ergebnisse zu Prävalenz, Inzidenz, Verlauf, Risikofaktoren. Z Orthop Grenzgeb 2005; 143: 292-298
• 42 Schmidt CO, Raspe H, Pfingsten M et al. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine (Phila Pa 1976) 2007; 32: 2005-2011
• 43 Schneider S, Mohnen SM, Schiltenwolf M et al. Comorbidity of low back pain: Representative outcomes of a national health study in the Federal Republic of Germany. Eur J Pain 2006; 11: 387-397
• 44 Shah RV. Spine pain classification: the problem. Spine (Phila Pa 1976) 2012; 37: 1853-1855
• 45 Sieper J, van der Heijde DMFM, Landewe R et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 2009; 68: 784-788
• 46 Statistisches Bundesamt, Robert Koch Institut – RKI. Gesundheitsberichterstattung des Bundes – Krankheitskosten 2006. Berlin 2010. Im Internet: http://www.gbebund.de Stand: 12.10.2010
• 47 UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004; 329: 1377
• 48 van Oostrom SH, Verschuren M, de Vet H et al. Longitudinal associations between physical load and chronic low back pain in the general population. Spine (Phila Pa 1976) 2012; 37: 788-796
• 49 von Korff M, Ormel J, Keefe FJ et al. Grading the severity of chronic pain. Pain 1992; 50: 133-149
• 50 Weiner DK, Rudy TE, Glick RM et al. Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults. J Am Geriatr Soc 2003; 51: 599-608
• 51 Wheeler SG, Wipf JE, Staiger TO et al. uptodate 2013. Approch to the diagnosis and evaluation of low back pain in adults. Im Internet:. http://www.uptodate.com/contents/approach-to-the-diagnosis-and-evaluation-of-low-back-pain-in-adults Stand: 27.08.2013
• 52 Wurmthaler C, Gerbershagen HU, Dietz G et al. Chronifizierung und psychologische Merkmale – Die Beziehung zwischen Chronifizierungsstadien bei Schmerz und psychophysischem Befinden, Behinderung und familiären Merkmalen. Z Gesundheitspsychol 1996; 4: 113-136
• 53 Yuan J, Purepong N, Kerr DP et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine (Phila Pa 1976) 2008; 33: E887-E900