Psychische Faktoren der Chronifizierung von Rückenschmerzen

Zusammenfassung

Diese Arbeit gibt einen kurzen Überblick über potenzielle psychische Faktoren der Chronifizierung von Rückenschmerz und ihre empirische Fundierung. Es gibt eine Reihe von plausiblen Modellen für die Chronifizierung, deren Bedeutung für das Schmerzgeschehen insgesamt z. T. belegt ist. Empirische Befunde, die die Bedeutung dieser Faktoren speziell für die Chronifizierung zeigen, sind jedoch sehr selten. So sind uns keine Arbeiten zur Prognose durch psychodynamische Faktoren bekannt. Depressivität trägt vermutlich nicht zur Chronifizierung von Rückenschmerzen bei, spielt aber ebenso wie Angst möglicherweise eine Rolle bei der Therapieresistenz chronischer Schmerzpatienten. Für operante Faktoren ist ein Beitrag zur Chronifizierung wahrscheinlich: Arbeitsunzufriedenheit ist ein wichtiger Prädiktor des Andauerns von Rückenschmerzen; Ausgleichszahlungen sind dem Therapieerfolg abträglich. Ob kognitive Faktoren Chronifizierung begünstigen, ist weiter eine offene Frage. Die ungünstigen Auswirkungen pessimistischer Erwartungen auf den Therapieverlauf sind jedoch mehrfach belegt.

Abstract

This article briefly reviews potential psychological factors relevant for the development of chronic back pain and their empirical foundations. There are several reasonable models for the chronic development which are meaningful for pain processes in general. However, there is little evidence that these factors also contribute to the persistence of back pain. We do not know of any study showing the development of chronic pain due to psychodynamic factors. Depressive symptoms are probably not followed by chronic pain. Possibly they play, such as anxiety symptoms, a role in treatment failure of chronic back pain. Several operant factors contribute to pain: work dissatisfaction predicts chronic back pain and the treatment of patients receiving compensation is less successful. The contribution of cognitive factors is still a moot point. An unfavourable impact of pessimistic expectations on treatment effects could be repeatedly demonstrated.

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