Leitliniengerechte medikamentöse Therapie des chronischen Rückenschmerzes

M. Maschke; M. A. Überall

doi:10.1055/s-0032-1332849

Aktuelle Neurologie, Table of Contents

Aktuelle Neurologie 2013; 40(02): 90-95
DOI: 10.1055/s-0032-1332849

Übersicht

Leitliniengerechte medikamentöse Therapie des chronischen Rückenschmerzes

Evidence-Based Treatment of Chronic Low Back Pain

Authors

M. Maschke

¹Abteilung für Neurologie und Neurophysiologie, Krankenhaus der Barmherzigen Brüder Trier
M. A. Überall

²Institut für Neurowissenschaften, Algesiologie und Pädiatrie (IFNAP), Nürnberg

Abstract

Zusammenfassung

Der chronische lumbale Rückenschmerz (syn.: chronischer Kreuzschmerz) ist eine der in der Medizin am häufigsten vorkommende Erkrankung mit einer immensen volkswirtschaftlichen Bedeutung. Die Ätiologie ist dabei vielfältig, wobei gerade in den letzten Jahren genetisch bedingte Prädispositionen wie z. B. Polymorphismen im Interleukin-1-Gen identifiziert wurden. Darüber hinaus scheinen muskuläre Erkrankungen wie z. B. das M.-piriformis-Syndrom oder auch myofasziale Schmerzsyndrome eine wichtige Rolle zu spielen. In Bezug auf die medikamentöse Schmerztherapie sollte das Medikament die Schmerzen wirksam unterdrücken, auch in der Langzeitanwendung nebenwirkungsarm bleiben, keine Gewöhnung hervorrufen und Chronifizierungsprozessen entgegenwirken. Der vorliegende Artikel fasst dabei die aus unterschiedlichen Leitlinien empfohlene Vorgehensweise zur medikamentösen Therapie zusammen und wertet kritisch neuere Daten zu einzelnen Substanzen. Auf die im Rahmen eines schmerztherapeutischen Gesamtkonzepts notwendigen nichtmedikamentösen Therapieformen wird in diesem Artikel nicht eingegangen.

Abstract

Chronic low back pain is one of the most frequent diseases in medicine with a high economic burden. The aetiology is heterogenous and multicausal, but recently genetic factors leading to a predisposition such as polymorphism in the interleukin-1 gene have been identified. Muscular diseases like piriformis muscle syndrome or myofascial pain syndrome appear to play an additional role in the pathogenesis. Medical pain treatment should use medications that are potent to reduce low back pain, should exhibit minor side effects and no potential for drug abuse and should prevent chronification. The present article summarises different and recent guidelines for the medical treatment of low back pain and evaluates recent studies investigating different substances. The review also includes a concise summary of non-medication treatment of low back pain but does not go into detail.

Schlüsselwörter

Rückenschmerz - Sensibilisierung - Schmerztherapie

Keywords

low back pain - sensitization - pain treatment

Full Text

References

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