Der Schmerzpatient 2018; 1(01): 7-18
DOI: 10.1055/s-0043-122097
Georg Thieme Verlag KG Stuttgart · New York

Schmerzmechanismen und Clinical Reasoning

Hannu Luomajoki
Ralf Schesser
Further Information

Publication History

Publication Date:
25 January 2018 (online)

Schmerz ist ein komplexes Konstrukt aus biologischen, psychologischen und sozialen Faktoren. Der vorliegende Übersichtsartikel konzentriert sich auf periphere und zentrale Schmerzmechanismen im Kontext des strukturierten Clinical-Reasoning-Prozesses und stellt mögliche psycho-soziale Einflüsse auf den Schmerz vor. Anhand der MOM-Mechanismen – Input, Processing und Output – wird schließlich deutlich, wie sich der „Schmerzkuchen“ eines Patienten zusammensetzt.

  • Literatur

  • 1 Benedetti F, Carlino E, Pollo A. How placebos change the patientʼs brain. Neuropsychopharmacology 2011; 36: 339-354 doi:10.1038/npp.2010.81
  • 2 Brinjikji W, Luetmer PH, Comstock B. et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol 2015; 36: 811-816 doi:10.3174/ajnr.A4173
  • 3 Butler D, Moseley L. Explain pain. Adelaide: Noigroup Publications; 2003
  • 4 Choi BK1 Verbeek JH, Tam WW. et al. Exercises for prevention of recurrences of low-back pain. Cochrane Database Syst Rev 2010; (01) CD006555 DOI: 10.1002/14651858.CD006555.pub2.
  • 5 Dahl J, Lundgren T. Living Beyond Your Pain. Oakland: New Harbinger; 2006
  • 6 Engers A, Jellema P, Wensing M. et al. Individual patient education for low back pain. Cochrane Database Syst Rev 2008; (01) CD004057 DOI: 10.1002/14651858.CD004057.pub3.
  • 7 Gifford L. Pain, the Tissues and the Nervous System: A conceptual model. Physiotherapy Journal 1998; 84: 27-36
  • 8 Henschke N, Maher CG, Refshauge KM. et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 2009; 60: 3072-3080 doi:10.1002/art.24853
  • 9 Jones M. Clinical reasoning: the foundation of clinical practice. Part 1. Aust J Physiother 1997; 43: 167-170
  • 10 Kendall NAS, Linton SJ, Main CJ. Guide to assessing psychosocial yellow flags in acute low back pain: Risk factors for long-term disability and work loss. Wellington, NZ: ACC; 1997
  • 11 Linton ST. Understanding pain for better clinical practice. A psychological perspective. London: Elsevier; 2005
  • 12 Luomajoki H. Schulterbeschwerden: Physiotherapie mit überlegenem Kosten-Nutzen-Verhältnis. Physiofacts 2013; 3
  • 13 Luomajoki H. Kreuzbandverletzung: Physiotherapie erzielt gleich gute Resultate wie die viel teurere Operation. Physiofacts; 2013 1.
  • 14 Luomajoki H. Muskuloskelettale Beschwerden als größte Kostenverursacher. Immenses Sparpotenzial durch Physiotherapie. Manuelle Medizin 2013; 51: 468-472 doi:10.1007/s00337-013-1066-0
  • 15 Maitland GEHE, Banks K, English K. Maitland Manipulation der Wirbelsäule. Heidelberg: Springer Medizin Verlag; 2006
  • 16 Merskey H, Bogduk N. Classification of Chronic Pain. Seattle: IASP Press; 1994
  • 17 Miller W, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford Press; 1991
  • 18 Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain 2004; 20: 324-330
  • 19 Muheim LLS, Senn O, Früh M. et al. Inappropriate use of arthroscopic meniscal surgery in degenerative knee disease. Acta Orthop 2017; 88: 550-555 doi:10.1080/17453674.2017.1344915
  • 20 Nijs J, Goubert D, Ickmans K. Recognition and Treatment of Central Sensitization in Chronic Pain Patients: Not Limited to Specialized Care. J Orthop Sports Phys Ther 2016; 46: 1024-1028
  • 21 Qaseem A, Wilt TJ, McLean RM. et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2017; 166: 514-530 doi:10.7326/M16-2367
  • 22 Ryösä A, Laimi K, Äärimaa V. et al. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil 2017; 39: 1357-1363 doi:10.1080/09638288.2016.1198431
  • 23 Sullivan MJ, Adams H, Horan S. et al. The role of perceived injustice in the experience of chronic pain and disability: scale development and validation. J Occup Rehabil 2008; 18: 249-261 doi:10.1007/s10926-008-9140-5
  • 24 Tracey I. Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans. Nat Med 2010; 16: 1277-1283 doi:10.1038/nm.2229
  • 25 Verra ML, Angst F, Brioschi R. et al. Effectiveness of subgroup-specific pain rehabilitation: a randomized controlled trial in patients with chronic back pain. Eur J Phys Rehabil Med 2017; DOI: 10.23736/S1973-9087.17.04716-5.
  • 26 Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000; 85: 317-332
  • 27 Williams AC, Craig KD. Updating the definition of pain. Pain 2016; 157: 2420-2423