Adipositas und Schmerzen – nur Ko-Morbiditäten oder mehr als das?

Zusammenfassung

Viele Schmerz-Patienten sind adipös und viele adipöse Patienten klagen über lokalisierte oder auch generalisierte Schmerzen. Dabei handelt es sich nicht nur um eine Ko-Inzidenz häufiger Erkrankungen. Adipositas kann durch mechanische Überlastung, aber auch durch die Wirkung proinflammatorischer Zytokine Schmerzen verursachen bzw. verstärken. Umgekehrt können Schmerzen z. B. durch Abnahme der körperlichen Aktivität oder Schlafstörungen auch zu einer (weiteren) Gewichtszunahme führen. Kompliziert wird die Gemengelage durch die Tatsache, dass eine Reihe individueller und sozio-ökonomischer Faktoren sowohl die Entwicklung einer Adipositas als auch die Schmerzzunahme und -chronifizierung fördern. In dieser Arbeit werden pathophysiologisch relevante Zusammenhänge zwischen Adipositas und Schmerzen beschrieben. Bei der Therapie adipöser Schmerzpatienten sollten die komplexen bio-psycho-sozialen Interaktionen berücksichtigt werden. Dies erfordert ein multimodales interdisziplinäres Vorgehen, das an verschiedenen Stellschrauben angreift.

Abstract

Many patients are obese and many obese patients complain of localised or generalised pain. This observation is not only due to the concurrence of frequent diseases. Obesity can enhance pain by mechanical overload and various effects of proinflammatory cytokines. On the other hand, pain can cause obesity due to physical inactivity and sleep problems. The interactions between obesity and pain are further complicated by the fact that numerous individual and socio-economic factors facilitate both the development of obesity and an increase and chronification of pain. In this article, the most relevant recognised pathophysiological interactions between obesity and pain are discussed. Knowledge of the complex bio-psycho-social interactions seems mandatory for the successful treatment of obese patients with pain. This implies a multimodal interdisciplinary treatment that considers the different aspects of the disease.

Schlüsselwörter

Adipositas - Schmerz - Zytokine - Entzündung - körperliche Aktivität

Key Words

obesity - pain - cytokines - inflammation - physical activity

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