Psychologische Schmerztherapie und Opioide — Ein Widerspruch?

Abstract

Prescription and accessibility of opioids for patients with non-malignant pain has considerably increased in recent years, and with it the number of patients who, in addition, use psychotherapy. So far no study exists yet on the efficacy, the advantages and disadvantages, or the problem points of this combination of treatments. This issue is of particular importance for interdisciplinary pain management programs as, due to selection biases, they admit a high percentage of patients with psychological distress and simultaneous opioid medication. The questions discussed concern diagnostics, indication, contraindication, and prescription criteria. Patients under distress seem to benefit less from opioids. At the same time, side effects of the medication might influence the psychological interventions negatively (e. g. cognitions or activity). By means of a case report, an example of how the two treatment options can be sensibly combined is presented.