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21.02.2024 | Rückenschmerzen | Pain clinical updates

Evidenzbasierte Interventionen zur Behandlung von chronischem Schmerz im unteren Rücken – Therapieauswahl für einen personalisierten Behandlungsansatz

Deutsche Fassung

verfasst von: Matthew C. Mauck, Aileen F. Aylward, Chloe E. Barton, Brandon Birckhead, Timothy Carey, Diane M. Dalton, Aaron J. Fields, Julie Fritz, Afton L. Hassett, Anna Hoffmeyer, Sara B. Jones, Samuel A. McLean, Wolf E. Mehling, Conor W. O’Neill, Michael J. Schneider, David A. Williams, Patricia Zheng, Ajay D. Wasan

Erschienen in: Der Schmerz

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Zusammenfassung

Hintergrund

Chronischer Schmerz im unteren Rücken („chronic low back pain“ [cLBP]) hat in den Vereinigten Staaten und auch weltweit eine hohe Prävalenz. Er führt zu funktioneller Beeinträchtigung und verringert die Lebensqualität. Während für cLBP viele Therapien verfügbar sind, liegen wenige Informationen darüber vor, welche spezifische Therapie bzw. welche spezifischen Therapien beim individuellen Patienten oder in einer Subgruppe von Patienten am besten wirkt bzw. wirken. Das Back Pain Research Consortium, ein Teilbereich der National Institutes of Health Helping to End Addiction Long-term^SM (HEAL) Initiative, wird eine kooperative klinische Studie durchführen, in der ein personalisierter medizinischer Algorithmus entwickelt werden soll, um die Wahl der Therapie durch Patienten und Behandler für Patienten mit cLBP zu optimieren.

Ziel

Hauptziele des vorliegenden Beitrags sind eine aktualisierte Übersicht zu evidenzbasierten cLBP-Interventionen und eine Beschreibung des Begutachtungs- und Auswahlprozesses für den Einschluss von Interventionen in die klinische Studie.

Methoden

Eine Arbeitsgruppe von cLBP-Experten prüfte und wählte Interventionen für den Einschluss in die klinische Studie aus. Primäre Beurteilungsmaße waren die Evidenzstärke und die Größe des Therapieeffekts. Soweit in der Literatur verfügbar wurden Wirkdauer, Anschlagzeit, Carry-over-Effekt, multimodale Wirksamkeit, Responder-Subgruppen und Evidenz für den Mechanismus des Therapieeffekts oder Biomarker berücksichtigt.

Schlussfolgerung

Die Arbeitsgruppe wählte vier maßgebende evidenzbasierte Therapien bei cLBP für die Testung in der klinischen Studie und für die Anwendung in der routinemäßigen klinischen Behandlung aus. Diese Therapien umfassen (1) die Gabe von Duloxetin, (2) Akzeptanz- und Commitment-Therapie, (3) eine klassifikationsbasierte Übungs- und manuelle Therapieintervention und (4) einen Selbstmanagementansatz. Der Evidenzlevel für einen Therapieeffekt war bei jeder dieser Interventionen moderat bis hoch, zudem stammen sie aus verschiedenen therapeutischen Klassen.

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Titel: Evidenzbasierte Interventionen zur Behandlung von chronischem Schmerz im unteren Rücken – Therapieauswahl für einen personalisierten Behandlungsansatz
Deutsche Fassung
verfasst von: Matthew C. Mauck
Aileen F. Aylward
Chloe E. Barton
Brandon Birckhead
Timothy Carey
Diane M. Dalton
Aaron J. Fields
Julie Fritz
Afton L. Hassett
Anna Hoffmeyer
Sara B. Jones
Samuel A. McLean
Wolf E. Mehling
Conor W. O’Neill
Michael J. Schneider
David A. Williams
Patricia Zheng
Ajay D. Wasan
Publikationsdatum: 21.02.2024
Verlag: Springer Medizin
Schlagwörter: Rückenschmerzen
Rückenschmerzen
Rückenschmerzen
Verhaltenstherapie
Erschienen in: Der Schmerz
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI: https://doi.org/10.1007/s00482-024-00798-x

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Evidenzbasierte Interventionen zur Behandlung von chronischem Schmerz im unteren Rücken – Therapieauswahl für einen personalisierten Behandlungsansatz

Deutsche Fassung