Multidisciplinary treatment program for chronic low back pain, part 1. Overview

Section: Multimodale Schmerztherapieunclassified

Multimodale Therapie bei chronischem HWS- und LWS-Schmerz

Neubauer

Zahlten-Hinguranage

Schiltenwolf

et al. 2006

“…Biologische Faktoren (wie Degenerationsvorgänge), funktionelle Veränderungen (Dekonditionierung durch schmerzbedingte Inaktivität) und psychosoziale Stressoren in Kombination sind ursächlich anzunehmen [10].…”

unclassified

“…Ein intensives Behandlungsprogramm ("functional restoration") mit dem Ziel der Wiedereingliederung in den Arbeitsprozess wurde untersucht [9,19], ähnliche Konzepte nahm das Göttinger Intensivprogramm für Rückenschmerzen erfolgreich auf [10,11]. Die Effektivität multidisziplinärer Interventionskonzepte in Hinblick auf Schmerz und Funktionalität beim KS gegenüber weniger intensiven stationären oder ambulanten Behandlungsmaß-nahmen wurde in einem systematischen Review [7] nachgewiesen Die Autoren beklagten aber den Mangel an genauer Patientencharakterisierung, Unterschiede in Art und Kombination der einzelnen Behandlungsmodalitäten und ihrer Intensität.…”

unclassified

Rehabilitation of non-specific low back pain

Arnold

Pfingsten

Wagner³

2007

In this study we documented the effectiveness of a 3-week multidisciplinary rehabilitative intervention in patients with chronic nonspecific low back pain. We compared the therapy group (136 patients: 91 female, 45 male) with a waiting list control group (34 patients: 25 female, 9 male). The patients showed chronic pain grades 1 and 2 (according to the Mainz Pain Staging System) and mild restriction of activity. Pain intensity, activity, participation, and health-related quality of life improved significantly in the intervention group (VAS from 46.34 to 25.91; FFbH-R from 19.79 to 18; PDI from 21.02 to 14.57; NHP from 161.83 to 120.97); the waiting list control group remained unchanged. The improvement was independent of age, gender, duration of disease, work status, or workplace satisfaction.

“…In Schmerzambulanzen zählen Schmerzsyndrome der Wirbelsäule zu den Hauptbeschwerdebildern [21]. Baumgartner [9] fand die Diagnose "low back pain" bei Personen zwischen 60 und 80 Jahren im Vergleich zu ihrem Bevölke-rungsanteil häufiger als bei solchen zwischen 40 und 60 Jahren.…”

unclassified

Fear Avoidance Beliefs und Funktion bei älteren Personen mit chronischem Rückenschmerz

Basler

Quint

Wolf

2006

Fear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain This analysis assessed how fear avoidance beliefs (FABs) affected subjective and objective functional parameters as well as pain in elderly individuals. The study comprised 152 elderly patients with low back pain, which was attributed to spondylosis in almost half of the cases. Their average age was 70.1 years (SD=4.3, range 65-84). All of the patients participated in a physiotherapeutic program including data acquisition before treatment (t1), immediately after its completion (t2), and 6 months later (t3). FABs were assessed by a five-item scale with satisfying psychometric properties. The primary outcome criterion was function, which was evaluated as a subjective measure using the Hannover functional disability scale and as an objective measure based on the anteflexion determined by ultrasound topometry. Secondary outcome criteria were pain parameters. At the time o the first measurement (t1), the patients were classified into three groups with strong, intermediate, or weak FABs. Analyses of variance reveal an improvement of subjective functional capacity in every FAB group between t1 and t2. At t3, there is a decline of these values only in the group of the high fear avoiders. High fear avoiders also show lower values in the objective measure at all three measurement points. No influence of the FABs on the pain parameters could be determined. It would be expected that the efficacy of physiotherapy could be improved if the patients' FABs are taken into consideration when planning the treatment regimen.