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Chronische untere Rückenschmerzen und psychische Komorbidität

Eine Übersicht

Chronic low back pain and psychological comorbidity

A review

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Zusammenfassung

Hintergrund

Rückenschmerzen zählen in Deutschland zu den häufigsten Beschwerden. Dieses Review dient der Evaluation der Komorbidität von chronischen unteren Rückenschmerzen („low back pain“ [LBP]) in Verbindung mit Depressivität und Angst.

Ziel der Arbeit

Die Ergebnisse sollen die Optimierung von Präventionsmaßnahmen, Leitlinien für eine Rehabilitation von Patienten mit LBP und die Entwicklung neuer Therapieansätze vorantreiben.

Material und Methoden

In einem systematischen Literaturreview wurden alle Primärpublikationen und Metaanalysen berücksichtigt, die unter festgelegten Suchkriterien in der Literaturdatenbank Medline (PubMed) verschlagwortet und bis zum Recherchestichtag publiziert waren. Des Weiteren wurden metaanalytische Berechnungen durchgeführt.

Ergebnisse

Es wurden 34 Studien identifiziert, die den Ein- und Ausschlusskriterien genügten, 14 davon wurden für eine Metaanalyse gewonnen. Die Datenlage zeigt signifikant unterschiedliche Depressionswerte für Betroffene mit LBP und gesunde Kontrollgruppen sowie Korrelationen zwischen Schmerzintensität, Depression und Angst. Für den Zusammenhang von LBP mit „Depression“ und „Schmerzintensität“ wurden 5 Studien mit hochsignifikantem Ergebnis (p < 0,01) identifiziert, 8 Studien wiesen einen signifikanten Zusammenhang auf (p < 0,05). Bei „Angst“ und „Schmerzintensität“ zeigten 4 Studien hochsignifikante (p < 0,01) und 3 Studien signifikante Zusammenhänge (p < 0,05), 5 Studien kamen zu keinen signifikanten Ergebnissen. Die Studien weisen eine große Heterogenität auf.

Schlussfolgerung

Die Ergebnisse können das Verständnis der Komplexität des Schmerzerlebens und die Grundlagen für die Behandlung von LBP-Patienten verbessern. Die Generalisierbarkeit der Ergebnisse ist eingeschränkt. Eine Differenzierung von Schmerzerleben und -beeinträchtigung sowie eine Standardisierung der Messinstrumente der psychischen Betroffenheit wären wünschenswert, damit die Vergleichbarkeit von Studienergebnissen erleichtert werden kann. Der Zusammenhang von chronischen LBP und psychischer Beeinträchtigung sollte weiter untersucht werden.

Abstract

Background

Back pain is a common, disabling problem in Germany. Previous research has evaluated associations between low back pain (LBP), depression, and fear.

Objectives

The results should provide ideas of how to optimize preventive measures, give guidelines for rehabilitation of patients with LBP, and to develop new therapies.

Materials and methods

A systematic review of the literature including primary publications and meta-analyses using set search criteria in PubMed was performed. A meta-analysis was then done.

Results

In all, 34 studies met the inclusion and quality criteria, whereby 14 studies were included in the meta-analysis. In the literature, significantly different depression scores were reported for people with LBP compared to a healthy control group. The pain perception in persons with LBP is associated with depression and fear. The correlation between depression and pain perception was highly significant in 5 studies (p < 0.01) and significant in 8 studies (p < 0.05). Fear and pain perception were highly significant in 4 studies (highly significant, p < 0.01) and significant in 3 studies (p < 0.05); 5 studies had no significant results. The studies were very heterogeneous.

Conclusions

The results can improve the understanding of the complexity of LBP perception and its therapy. The generalization of the results is limited. To cover the correlation of psychosocial and lifestyle factors and pain perception of LBP, further research is required. To obtain a clearer picture of pain perception in persons with LBP, standardized pain assessment would be beneficial. In addition, we recommend that future studies follow standardized procedures to allow greater comparability.

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Danksagung

Diese Studie wurde unterstützt durch die Deutsche Gesetzliche Unfallversicherung (412.02-FB-0200).

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Authors and Affiliations

  1. Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    J. Bletzer, S. Gantz, T. Voigt, E. Neubauer & M. Schiltenwolf

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  1. J. Bletzer
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  2. S. Gantz
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  3. T. Voigt
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Correspondence to J. Bletzer.

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Interessenkonflikt

J. Bletzer, S. Gantz, T. Voigt, E. Neubauer und M. Schiltenwolf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bletzer, J., Gantz, S., Voigt, T. et al. Chronische untere Rückenschmerzen und psychische Komorbidität. Schmerz 31, 93–101 (2017). https://doi.org/10.1007/s00482-016-0143-4

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