Leitliniengerechte Schmerztherapie

Zusammenfassung

In den gültigen Leitlinien des DVO (Dachverband der deutschsprachigen osteologischen Fachgesellschaften) wird bezüglich der Schmerztherapie bei Osteoporose auf das WHO-Stufenschema verwiesen. Dort wird empfohlen, dass zunächst ein Analgetikum der WHO-Stufe 1 (Nicht- opioid) eingesetzt werden soll, bevor – bei nicht ausreichender Wirkung – Opioide zugegeben werden. Der Metabolismus für Analgetika verändert sich im Alter und bei älteren Menschen muss mit einer Vielzahl von Komorbiditäten und Arzneimittel-Interaktionen gerechnet werden. Deshalb sind die vorhandenen Daten, die überwiegend aus der Therapie von Rückenschmerzen anderer Ursache stammen, nur mit großen Einschränkungen auf die Behandlung osteoporotischer Frakturschmerzen übertragbar. Gerade beim alten Menschen gibt es zusätzliche Nebenwirkungen; dabei sind Schwindel und Sturzneigung beim Osteoporosepatienten besonders relevante Nebenwirkungen einer Schmerztherapie.

Summary

The current DVO-guidelines for the treatment of osteoporosis refer to the WHO pain ladder for pain therapy in osteoporotic fractures. The WHO pain ladder states that a nonopioid analgesic (WHO stage 1) should be used as first line therapy before opioids should be added. Drug metabolism is greatly altered in elderly patients and comorbidity and drug interactions must be considered in patients with osteoporotic fractures. Therefore data from back pain of other causes cannot be translated into this patient population. In elderly patients side effects like nausea and the risk of falling must be considered when prescribing analgesic drugs after osteoporotic fractures.

Schlüsselwörter

Leitlinie - Schmerztherapie - Osteoporose

Keywords

Guideline - pain therapy - osteoporosis

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