Häufigkeit chronischer Schmerzen nach Arbeitsunfall – Eine erste Statuserhebung im BG-lichen Heilverfahren einer Tertiärklinik

Zusammenfassung

Hintergrund Chronischer Schmerz ist nach Unfällen und Operationen eine Langzeitkomplikation, deren Relevanz für Patienten im BG-lichen Heilverfahren in Deutschland kaum untersucht ist.

Fragestellung Erste Statuserhebung der Häufigkeit chronischer Schmerzen nach Arbeitsunfall.

Methoden In 2017 wurden chirurgisch-stationäre BG-Patienten (18–65 J.) eines Tertiärkrankenhauses zu chronischen Schmerzen, die seit einem BG-lich anerkannten Trauma bestanden (Intervall 2,8±6,9 Jahre), ungeachtet einer stattgehabten Versorgung, erstmalig zum Zeitpunkt eines Krankenhausaufenthalts und dann telefonisch 6 Monate später befragt. Der Fokus lag auf Patienten mit einem Arbeitsunfall (A) innerhalb des letzten Monats oder (B) >6 Monaten. Primäres Outcome: Häufigkeit arbeitsunfallbedingter chronischer Schmerzen (>6 Monate) zum Initialinterview (Punktprävalenz), sekundäre Outcomes: Häufigkeit einer Chronifizierung nach 6 Monaten (A) und Persistenz chronischer Schmerzen (B). Tertiäre Outcomes: Arbeitsfähigkeit, Verletzungsartenverfahren, Auswirkungen anhand Schmerzintensität, -lokalisation und -medikation, Funktionseinschränkung in Abhängigkeit der Existenz chronischer Schmerzen sowie Komorbidität.

Ergebnisse 415 Patienten wurden eingeschlossen, 85% (160/188) berichteten von unfallabhängigen chronischen Schmerzen (überwiegend mittlere bis sehr starke Intensität, an Gelenken und Knochen lokalisiert). 90% (131/145) gaben diese Schmerzen auch sechs Monate später an. 67% (64/96) gaben erstmalig chronische Schmerzen an. Patienten mit chronischen Schmerzen zum Follow-up (281/369) nahmen seltener ihre Berufstätigkeit wieder auf (p=0,003), in 60% Analgetika ein, waren öfter komorbide (p<0,002) und stärker in ihrer Extremitätenfunktionalität beeinträchtigt (p<0,002).

Schlussfolgerung Auch wenn die Ergebnisse als vorläufig zu bewerten sind, scheinen chronische Schmerzen nach Arbeitsunfall sehr häufig und beeinflussen die Wiederherstellung der Arbeitsfähigkeit langfristig negativ. Anhand der vorliegenden anamnestischen Zahlen ist eine weiterführende differenzierte Reevaluation prospektiver Daten unter Beachtung therapeutischer Maßnahmen dringend anzuraten.

Abstract

Background Chronic pain after trauma and surgery is a long-term complication. Its relevance for patients within the workers‘ compensation rehabilitation process has not been adequately investigated.

Objectives Initial evaluation of frequency of chronic pain after occupational accidents.

Methods In 2017, surgical inpatients (18–65 y) treated in a tertiary hospital were asked about chronic pain arising from an occupational trauma recognized by statutory occupation insurance (interval 2.8±6.9 years), regardless of care received, first at the time of hospitalization and then by telephone interview 6 months later. The focus was on patients with a work-related trauma (A) within the past month or (B) >6 months. Primary outcome: frequency of work trauma-related chronic pain (>6 months) at the initial interview (point prevalence), secondary outcomes: frequency of chronicity at 6 months (A) and persistence of chronic pain (B). Tertiary outcomes: ability to work, occupational injury classification, burden based on pain intensity, localization, and medication, functional deficits due to the existence of chronic pain, and comorbidity.

Results Out of 415 patients included in the survey, 85% (160/188) reported accident-related chronic pain (predominantly moderate to highly severe in intensity, localized at joints and bones). 90% (131/145) also reported this pain six months later. 67% (64/96) reported chronic pain for the first time. Patients with chronic pain at follow-up (281/369) were less likely to return to work (p=0.003), required analgesics in 60%, were more often comorbid (p<0.002) and had greater functional deficits (p<0.002).

Conclusion Despite the preliminary nature of the data, chronic pain seems to be common after occupational trauma and negatively affects the recovery of work ability in the long term. Based on the present observational data, a further differentiated re-evaluation of prospective data considering therapeutic measures is strongly recommended.

Schlüsselwörter

chronischer Schmerz - BG-liches Heilverfahren - Trauma - Arbeitsunfähigkeit

Key words

chronic pain - statutory occupational insurance system - trauma - inability to work

Publication History

Article published online:
09 October 2023

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