Schmerzen bei Osteoporose

Zusammenfassung

Schmerzen nach osteoporotischen Frakturen verschlechtern nicht nur die Lebensqualität, sondern haben auch erhebliche Auswirkungen auf Mobilität, Schlaf, Angst und Depressionen und haben darüber hinaus psychosoziale Folgen. Mit zunehmender Zahl osteoporotischer Frakturen nimmt die Krankheitslast zu. Kontrollierte Untersuchungen über den natürlichen Verlauf nach osteoporotischen Frakturen sind kaum vorhanden. Die Kenntnis der Schmerzphysiologie und der Mechanismen, die zu Osteoporoseschmerzen führen, ist wichtig bei der Auswahl geeigneter Therapiemethoden. Eine effektive Schmerztherapie ist notwendig, um eine Schmerzchronifizierung zu verhindern. Die Schmerztherapie sollte multimodal sein und neben der medikamentösen Therapie auch Physiotherapie und Rehabilitation sowie Maßnahmen zur Verhinderung psychosozialer Folgestörungen umfassen.

Summary

Pain after osteoporotic fractures impair quality of life. Fractures result in impaired mobility, sleep disorders, fear and depression and psychosocial impairment. Additional fractures cause additional burden of disease. Controlled data about the natural history of osteoporotic pain are rare. Knowledge of pain mechanisms helps to initiate adequate analgesic measures. Effective pain therapy is important to prevent chronic pain. Pain therapy should include pharmacologic therapy, physiotherapy and rehabilitation and measures to prevent psychosocial sequelae of osteoporotic fractures.

Schlüsselwörter

Osteoporose - Schmerz - Bewegungsschmerz - Analgesie - Rehabilitation

Keywords

Osteoporosis - pain - motion-related pain - analgesia - rehabilitation

• Literatur

• 1 AGS Panel on chronic pain in older persons. The management of chronic pain in older persons. American geriatrics society. J Am Geriatr Soc 1998; 46: 635-651.
• 2 AGS Panel on persistent pain in older persons. The management of persistent pain in older persons. American geriatrics society. J Am Geriatr Soc 2002; 50: 205-224.
• 3 Black DM, Cummings SR, Karpf DB. et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture intervention research group. Lancet 1996; 348: 1535-1541.
• 4 Cohen ML. Principles of pain and pain management. In: Klippel JH, Dieppe PA. Rheumatology. 2nd ed.. Mosby; 1998. 4.1–6.
• 5 Cooper C. Epidemiology and public health impact of osteoporosis. Baillere Clin Rheumatol: Osteoporosis 1993; 07: 459-477.
• 6 Cooper C, Atkinson EJ, O`Fallon WM. et al. Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota, 1985–1989. J Bone Min Res 1992; 07: 221-227.
• 7 Gold D, Stegmaier K, Bales C. et al. Psychococial functioning and osteoporosis in late life: results of a multidiciplinary intervention. J Womens Health 1993; 02: 149-155.
• 8 Ferell BA. Pain evaluation and management in the nursing home. Ann Intern Med 1995; 123: 681-687.
• 9 Francis RM, Aspray TJ, Hide G, Sutcliffe AM. Back pain in osteoporotic fractures. Osteoporos Int 2008; 19: 895-903.
• 10 Friedrich M, Gittler G, Pieler-Bruh E. Misleading history of pain location in 51 patients with osteoporotic vertebral fractures. Eur Spine J 2006; 15: 1797-1800.
• 11 Giesecke T, Gracely RH, Clauw DJ. et al. Zentrale Schmerzverarbeitung beim chronischen Rückenschmerz. Schmerz 2006; 20: 411-417.
• 12 Gold D. The nonskeletal consequences of osteoporotic fractures: psychologic and social outcomes. Rheum Dis Clin North Am 2001; 27: 271-280.
• 13 Hasserius R, Karlsson MK, Jonsson B. et al. Long term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly – a 12– and 22-year follow-up of 257 patients. Calcif Tissue Int 2005; 76: 235-242.
• 14 Jensen AL, Harder I. The osteoporotic pain experience. Osteoporosis Int 2004; 15: 204-208.
• 15 Lukert BP. Vertebral compression fractures. How to manage pain, avoid disability. Geriatrics 1994; 49: 22-26.
• 16 McNally EG, Wilson DJ, Ostlere SJ. Limited magnetic resonance imaging in low back pain instead of plain radiographs. Experience with first 1000 cases. Clin Radiol 2001; 56: 922-925.
• 17 Melzack R, Casey L. Sensory, motivational and central control determinants of pain. In: Kenshalo R. The skin senses. Springfield: Charles C Thomas; 1968: 423-443.
• 18 Neill TWO, Cockerill W, Matthis C. et al. Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporosis Int 2004; 15: 760-765.
• 19 Nevitt MC, Ettinger B, Black DM. et al. The association of radiographically detected vertebral fractures with back pain and function. A prospective study. Ann Intern Med 1998; 128: 793-800.
• 20 Oleksik A, Lips P, Dawson A. et al. Health related quality of life in women with low BMD with or without prevalent vertebral fractures. J Bone Mineral Res 2000; 15: 1384-1392.
• 21 Parmelee PA, Katz IR, Lawton MP. The relation of pain to depression among institutionalized patients. J Gerontol 1991; 46: 15-21.
• 22 Roy DK, O`Neill DW, Finn JD. et al. Determinants if incident vertebral fractures in men and women: results from the European Prospective Osteoporosis study (EPOS). Osteoporos Int 2003; 14: 19-26.
• 23 Scane AC, Francis RM, Sutcliffe AM. et al. Casecontrol study of the pathogenesis and the sequelae of symptomatic vertebral fractures in men. Osteoporos Int 1999; 09: 91-97.
• 24 Silverman SL, Mainshall M, Shen W. et al. The relationship of health related quality of life to prevalent and incident verebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcome of Raloxifene Evaluaton study. Arthritis Rheum 2001; 44: 2611-2519.
• 25 Toyone D, Toyone T, Tanaka T. et al. Changes in vertebral wedging rate between supine and standing position and its association with back pain: a prospective study in patients with osteoporotic vertebral compression fractures. Spine 2006; 31: 2963-2966.