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Chronische Rückenschmerzen

Chronic lower back pain

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Zusammenfassung

In Anbetracht der geringen Effektivität bei der Behandlung unspezifischer Rückenschmerzen und der damit verbundenen Tendenz zur Chronifizierung wurde ein fachgebietsübergreifendes Handlungskonzept auf Basis evidenzbasierter Therapieleitlinien notwendig. Dies erfüllt die durch das Ärztliche Zentrum für Qualität in der Medizin publizierte Nationale Versorgungsleitlinie zu Kreuzschmerzen. Durch systematisch entwickelte und bewertete Algorithmen werden Empfehlungen zu Diagnostik und Therapie sämtlicher Subformen unspezifischer Rückenschmerzen aufgelistet. Insbesondere bei chronischen Rückenschmerzen werden unter Berücksichtigung psychosozialer Kofaktoren multimodale Konzepte favorisiert. Bei überwiegend günstigen Spontanverläufen soll eigenverantwortliches aktives Handeln seitens des Patienten unterstützt werden, während vor allem invasive Therapiemaßnahmen in den Hintergrund treten. Im günstigen Fall kann so die übermäßige Medikalisierung des Phänomens Rückenschmerzen überwunden werden. Zu hinterfragen ist, ob diese Leitlinien unnötigerweise auf unspezifische Rückenschmerzen beschränkt sind.

Summary

Poor efficiency in terms of treatment of unspecific back pain and related chronic pain syndromes has led to the necessity of general care guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). Systematically validated and reviewed algorithms have been established for all kinds of unspecific back pain, covering both acute and chronic syndromes. Concerning the impact of psychosocial risk factors in the development of chronic LBP, multimodal treatment is preferred to monomodal strategies. Self-responsible acting on the part of the patient should be supported while invasive methods in particular, i.e. operative treatment, should be avoided due to lacking evidence in outcome efficiency.

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  1. Stiftung Orthopädische Universitätsklinik, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    A. Werber &  M. Schiltenwolf

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  1. A. Werber
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  2. M. Schiltenwolf
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Correspondence to A. Werber or M. Schiltenwolf.

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Werber, A., Schiltenwolf, M. Chronische Rückenschmerzen. Nervenarzt 83, 243–258 (2012). https://doi.org/10.1007/s00115-011-3421-5

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