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Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport

Von der Modellbildung zum klinischen Screening – ein Review aus dem MiSpEx-Netzwerk

Psychosocial risk factors for chronic back pain in the general population and in competitive sports

From theory to clinical screening—a review from the MiSpEx network

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Zusammenfassung

Hintergrund

Lumbale Rückenschmerzen und ihre Neigung zur Chronifizierung stellen nicht nur in der Allgemeinbevölkerung, sondern auch im Leistungssport ein bedeutendes Gesundheitsproblem dar. Im Gegensatz zu Nichtathleten ist die Erforschung psychosozialer Risikofaktoren sowie von Screeningfragebögen, die möglichst frühzeitig die Entwicklung chronischer Schmerzen erkennen und vorhersagen können, im Leistungssport noch in den Anfängen. Das vorliegende systematische Review gibt einen Überblick über den Stand der Risikofaktorenforschung in beiden Feldern und untersucht die prädiktive Qualität verschiedener Screeningfragebögen bei Nichtathleten.

Methodik

Die Literatursuche erfolgte zwischen März und Juni 2016 in den Datenbanken MEDLINE, PubMed und PsycINFO mit den Suchbegriffen „psychosocial screening“, „low back pain“, „sciatica“ und „prognosis“, „athletes“. Eingeschlossen wurden prospektive Studien an Patienten mit lumbalen Rückenschmerzen mit und ohne Ausstrahlung in das Bein, ≥18 Jahre und mit einem Follow-up von mindestens 3‑monatiger Dauer.

Ergebnisse

In das Review zu Screeninginstrumenten wurden 16 Studien einbezogen. Alle waren an klinischen Stichproben der Allgemeingesellschaft durchgeführt worden. Zu den am häufigsten publizierten Screeningfragebögen gehören der Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) mit einer zufriedenstellenden Früherkennung der Wiederherstellung der Arbeitsfähigkeit sowie das STarT Back Screening Tool (SBT) mit guter Vorhersage schmerzbedingter Beeinträchtigung. Für die Vorhersage künftiger Schmerzen eignen sich die Risikoanalyse der Schmerzchronifizierung (RISC-R) und der Heidelberger Kurzfragebogen (HKF).

Schlussfolgerungen

Psychosoziale Risikofaktoren für chronische Rückenschmerzen, wie z. B. chronischer Stress, ungünstige Schmerzverarbeitung und depressive Stimmungslagen, werden zunehmend auch im Leistungssport erkannt. Screeninginstrumente, die sich in der Allgemeingesellschaft als hinreichend vorhersagestark erwiesen haben, werden aktuell im MiSpEx-Forschungsverbund auf ihre Eignung überprüft.

Abstract

Background

Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes.

Methods

The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords “psychosocial screening”, “low back pain”, “sciatica” and “prognosis”, “athletes”. We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a follow-up of at least 3 months.

Results

We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF).

Conclusion

Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.

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Authors and Affiliations

  1. Abteilung für Medizinische Psychologie und Soziologie, Fakultät für Medizin, Ruhr-Universität Bochum, Universitätsstr. 150, Bochum, Deutschland

    M. I. Hasenbring, C. Levenig & D. Hallner

  2. Professur für Sport- und Gesundheitssoziologie, Department für Gesundheitswissenschaften, Universität Potsdam, Potsdam, Deutschland

    A.-K. Puschmann, A. Weiffen & P.-M. Wippert

  3. Abteilung für Gesundheit und Sozialpsychologie, Institut für Psychologie, Deutsche Sporthochschule Köln, Köln, Deutschland

    J. Kleinert & J. Belz

  4. Konservative Orthopädie und Tagesklinik für Schmerztherapie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    M. Schiltenwolf & A.-C. Pfeifer

  5. Lehr- und Forschungsbereich Sportpsychologie, Fakultät für Sportwissenschaft, Ruhr-Universität Bochum, Bochum, Deutschland

    J. Heidari & M. Kellmann

  6. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australien

    M. Kellmann

  7. Department für Gesundheitswissenschaften und Technologie, Eidgenössische Technische Universität Zürich, Zürich, Schweiz

    P.-M. Wippert

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  1. M. I. Hasenbring
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  2. C. Levenig
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  9. A.-C. Pfeifer
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Correspondence to M. I. Hasenbring.

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M.I. Hasenbring, C. Levenig, D. Hallner, A.-K. Puschmann, A. Weiffen, J. Kleinert, J. Belz, M. Schiltenwolf, A.-C. Pfeifer, J. Heidari, M. Kellmann und P.-M. Wippert geben an, dass kein Interessenkonflikt besteht.

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Hasenbring, M.I., Levenig, C., Hallner, D. et al. Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport. Schmerz 32, 259–273 (2018). https://doi.org/10.1007/s00482-018-0307-5

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