Zusammenfassung
Hintergrund: Rückenbeschwerden haben in den westlichen Industrienationen eine Prävalenz von bis
zu 80 %. Rückenschmerzen sind die zweithäufigste Ursache für einen Arztbesuch. Die
verursachten Kosten für das Gesundheitswesen sind proportional zum subjektiv erlebten
Schmerz. Ziel dieser Studie war es festzustellen, ob sich durch die Anwendung von
Kernspinresonanztherapie der Krankenstand bei Patienten mit diskogener Radikulopathie
verändert. Patienten und Methode: Die Anwendung von Kernspinresonanztherapie auf Rückenschmerz bei diskogener Radikulopathie
wurde doppelblind, prospektiv randomisiert, gesundheitsökonomisch evaluiert. Patienten
im Alter von 20 bis 55 Jahren mit Lumboischialgie ohne Indikation zur chirurgischen
Intervention wurden eingeschlossen. Die Zahl der Krankenstandstage in einer Versuchsgruppe
vor und nach Magnetfeldtherapie und in einer Kontrollgruppe wurde 2‐fach erhoben.
Die Krankenstandstage wurden mittels Schmerztagebuch und mittels telefonischer Rückfrage
ermittelt. Ergebnisse: Jene Patienten, die mit eingeschalteter Kernspinresonanztherapieanlage behandelt
wurden, hatten signifikant weniger Krankenstandstage (p = 0,009), wenn diese mittels
direkter, persönlicher, telefonischer Rücksprache ermittelt wurden. Der Krankenstand
vor Therapie betrug 14,7 Tage, nach Therapie 5,8 Tage. Im Gegensatz dazu ließ sich
der Krankenstand der Kontrollgruppe vor Therapie mit 7,6 Tagen und nach Therapie mit
13,8 Tagen errechnen. Die Dauer der Beschwerden zeigte einen negativen Zusammenhang
mit den Krankenstandstagen. Bei Angabe einer beruflichen Belastung wurden signifikant
mehr Krankenstandstage (8,3 Tage) in Anspruch genommen als ohne berufliche Belastung
(3,2 Tage). Diese Korrelation besteht jedoch nicht bei einer familiären Belastung.
Die Kosteneffektivitätsanalyse ergab eine Kompensation der direkten Kosten für die
Kernspinresonanztherapie in unterschiedlichem Ausmaß je nach Berufsgruppe. Für Arbeiter
kompensierten 16,9 Tage, für Angestellte 11,4 Tage und für Beamte 9,1 Tage weniger
Krankenstand die direkten und indirekten Kosten der Kernspinresonanztherapie. Schlussfolgerung: Die Studie konnte durch Messung der Krankenstandstage bestätigen, dass durch eine
relativ billige alternative Technik eine Schmerzlinderung und damit auch ein gesundheitsökonomischer
Nutzen erzielt werden können. Problematisch sind Patienten, die sich in Arbeitslosigkeit
oder in einem laufenden Rentenverfahren befinden, weil sie womöglich nicht gesundgeschrieben
werden wollen.
Abstract
Background: The prevalence of spinal symptoms in Western industrialised countries ranges up to
80 %. Back pain ranks second among the most common reasons to seek medical advice.
The resulting financial burden on the health-care system is proportional to the subjectively
experienced pain. The aim of the present study was to determine whether the use of
magnetic resonance therapy alters the duration of sickness absence in patients with
discogenic radiculopathy. Patients and Method: In a double-blind prospective randomised study, the use of magnetic resonance therapy
for back pain in patients with discogenic radiculopathy was evaluated in the context
of health economics. Patients aged 20 to 55 years with lumboischialgia and no indication
for surgery were included in the study. The primary variable was the number of days
of sickness absence in a study group before and after magnetic field therapy, and
in a control group. The number of days of sickness absence was determined on the basis
of a pain diary and by telephone inquiry. Results: Patients who were treated with an activated magnetic resonance therapy device had
significantly fewer days of sickness absence (p = 0.009) when evaluated by personal
telephone calls. The duration of sickness absence before therapy was 14.7 days and
that after therapy 5.8 days. In contrast, the days of sickness absence in the control
group were 7.6 days before therapy and 13.8 days after therapy. The duration of symptoms
was negatively correlated with the days of sickness absence. Patients who reported
a burden at work had more days of sickness absence (8.3 days) than those with no burden
at work (3.2 days). This correlation does not apply to familial burden. The cost-effectiveness
analysis showed different degrees of compensation of the cost of magnetic resonance
therapy, depending on the occupational group. Direct and indirect costs of magnetic
resonance therapy were compensated by 16.9 fewer days of sickness absence among workers,
11.4 fewer days of sickness absence among employees, and 9.1 fewer days of sickness
absence among civil servants. Conclusion: Based on the number of days of sickness absence, the study confirmed that a relatively
economical alternative technique is able to provide pain relief as well as benefit
the health economy. Unemployed patients or patients who have submitted an application
for a pension may be problematic because they may not wish to be pronounced healthy
by their doctors.
Schlüsselwörter
Rückenschmerz - Kernspinresonanztherapie - Krankenstand
Key words
back pain - magnetic resonance therapy - sickness absence
Literatur
1
Rubin D I.
Epidemiology and risk factors for spine pain.
Neurol Clin.
2007;
25
353-371
2
Schoeggl A, Reddy M, Matula C.
Functional and economic outcome following microdiscectomy for lumbar disc herniation
in 672 patients.
J Spinal Disord Tech.
2003;
16
150-155
3
Briggs A M, Smith A J, Straker L M et al.
Thoracic spine pain in the general population: prevalence, incidence and associated
factors in children, adolescents and adults. A systematic review.
BMC Musculoskelet Disord.
2009;
10
77
4
Breivik H, Collett B, Ventafridda V et al.
Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.
Eur J Pain.
2006;
10
287-333
5
Walker B F, Muller R, Grant W D.
Low back pain in Australian adults: the economic burden.
Asia Pac J Public Health.
2003;
15
79-87
6
Kloth D S, Fenton D S, Andersson G B et al.
Intradiscal electrothermal therapy (IDET) for the treatment of discogenic low back
pain: patient selection and indications for use.
Pain Physician.
2008;
11
659-668
7
Santilli V, Beghi E, Finucci S.
Chiropractic manipulation in the treatment of acute back pain and sciatica with disc
protrusion: a randomized double-blind clinical trial of active and simulated spinal
manipulations.
Spine J.
2006;
6
131-137
8
Reinhold M, Blauth M, Rosiek R et al.
[Lower cervical spine trauma: classification and operative treatment].
Unfallchirurg.
2006;
109
471-480
9
Wetzel F T, Donelson R.
The role of repeated end-range/pain response assessment in the management of symptomatic
lumbar discs.
Spine J.
2003;
3
146-154
10
Gibson J N, Grant I C, Waddell G.
Surgery for lumbar disc prolapse.
Cochrane Database Syst Rev.
2000;
CD001350
11
Hirsch J A, Singh V, Falco F J et al.
Automated percutaneous lumbar discectomy for the contained herniated lumbar disc:
a systematic assessment of evidence.
Pain Physician.
2009;
12
601-620
12
Korecki C L, Costi J J, Iatridis J C.
Needle puncture injury affects intervertebral disc mechanics and biology in an organ
culture model.
Spine (Phila Pa 1976).
2008;
33
235-241
13
Manchikanti L, Derby R, Benyamin R M et al.
A systematic review of mechanical lumbar disc decompression with nucleoplasty.
Pain Physician.
2009;
12
561-572
14
Yeung A T, Yeung C A.
Advances in endoscopic disc and spine surgery: foraminal approach.
Surg Technol Int.
2003;
11
255-263
15
Chou R, Atlas S J, Stanos S P et al.
Nonsurgical interventional therapies for low back pain: a review of the evidence for
an American Pain Society clinical practice guideline.
Spine (Phila Pa 1976).
2009;
34
1078-1093
16
Chou R, Baisden J, Carragee E J et al.
Surgery for low back pain: a review of the evidence for an American Pain Society Clinical
Practice Guideline.
Spine (Phila Pa 1976).
2009;
34
1094-1109
17
Bassett C A.
Fundamental and practical aspects of therapeutic uses of pulsed electromagnetic fields
(PEMFs).
Crit Rev Biomed Eng.
1989;
17
451-529
18
Quittan M, Schuhfried O, Wiesinger G F et al.
[Clinical effectiveness of magnetic field therapy – a review of the literature].
Acta Med Austriaca.
2000;
27
61-68
19 Statistik Austria .Lohnsteuerstatistik 2007. Wien: Bundesanstalt Statistik Österreich;
2008
20
Shupak N M, Prato F S, Thomas A W.
Human exposure to a specific pulsed magnetic field: effects on thermal sensory and
pain thresholds.
Neurosci Lett.
2004;
363
157-162
21
Andrews D W, Lavyne M H.
Retrospective analysis of microsurgical and standard lumbar discectomy.
Spine (Phila Pa 1976).
1990;
15
329-335
22
Jensdottir M, Gudmundsson K, Hannesson B et al.
20 years follow-up after the first microsurgical lumbar discectomies in Iceland.
Acta Neurochir (Wien).
2007;
149
51-58
23
Awad J N, Moskovich R.
Lumbar disc herniations: surgical versus nonsurgical treatment.
Clin Orthop Relat Res.
2006;
443
183-197
24
Biyani A, Andersson G B, Chaudhary H et al.
Intradiscal electrothermal therapy: a treatment option in patients with internal disc
disruption.
Spine (Phila Pa 1976).
2003;
28
S8-S14
25
Fritz J M, Cleland J A, Childs J D.
Subgrouping patients with low back pain: evolution of a classification approach to
physical therapy.
J Orthop Sports Phys Ther.
2007;
37
290-302
26
Furlan A D, van Tulder M, Cherkin D et al.
Acupuncture and dry-needling for low back pain: an updated systematic review within
the framework of the Cochrane collaboration.
Spine (Phila Pa 1976).
2005;
30
944-963
27
Gagnier J J, van Tulder M, Berman B et al.
Herbal medicine for low back pain.
Cochrane Database Syst Rev.
2006;
CD004504
28
Gagnier J J, van Tulder M W, Berman B et al.
Herbal medicine for low back pain: a Cochrane review.
Spine (Phila Pa 1976).
2007;
32
82-92
29
Huntley A L, Coon J T, Ernst E.
Complementary and alternative medicine for labor pain: a systematic review.
Am J Obstet Gynecol.
2004;
191
36-44
30
Rabinstein A A, Shulman L M.
Acupuncture in clinical neurology.
Neurologist.
2003;
9
137-148
31
van Tulder M W, Furlan A D, Gagnier J J.
Complementary and alternative therapies for low back pain.
Best Pract Res Clin Rheumatol.
2005;
19
639-654
32
Weiner D K, Ernst E.
Complementary and alternative approaches to the treatment of persistent musculoskeletal
pain.
Clin J Pain.
2004;
20
244-255
33
Zareba G.
Phytotherapy for pain relief.
Drugs Today (Barc).
2009;
45
445-467
34
Zeeliger A, Bersnev V P.
[Neurostimulation in patients with chronic neuropathic pain in the so-called failed
back surgery syndrome (world and the author's experience)].
Zh Vopr Neirokhir Im N N Burdenko.
2007;
53-57
35
Cherkin D C, Sherman K J, Deyo R A et al.
A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage
therapy, and spinal manipulation for back pain.
Ann Intern Med.
2003;
138
898-906
36
Johnson W G.
Cost-based evaluations of the treatment of back pain: a primer for health-care professionals.
Spine J.
2005;
5
361-369
37
White A R, Ernst E.
Economic analysis of complementary medicine: a systematic review.
Complement Ther Med.
2000;
8
111-118
38
Cutler R B, Fishbain D A, Rosomoff H L et al.
Does nonsurgical pain center treatment of chronic pain return patients to work? A
review and meta-analysis of the literature.
Spine (Phila Pa 1976).
1994;
19
643-652
39
Webster B S, Snook S H.
The cost of 1989 workers' compensation low back pain claims.
Spine (Phila Pa 1976).
1994;
19
1111-1115
40
Webster B S, Verma S K, Gatchel R J.
Relationship between early opioid prescribing for acute occupational low back pain
and disability duration, medical costs, subsequent surgery and late opioid use.
Spine (Phila Pa 1976).
2007;
32
2127-2132
41
Fialka-Moser V, Vacariu G, Crevenna R et al.
[The role of gender medicine in rehabilitation].
Wien Med Wochenschr.
2004;
154
416-422
42
Adams M A.
Biomechanics of back pain.
Acupunct Med.
2004;
22
178-188
43
Brisby H.
Pathology and possible mechanisms of nervous system response to disc degeneration.
J Bone Joint Surg [Am].
2006;
88
68-71
44
Carragee E J, Hannibal M.
Diagnostic evaluation of low back pain.
Orthop Clin North Am.
2004;
35
7-16
45
Freemont A J.
The cellular pathobiology of the degenerate intervertebral disc and discogenic back
pain.
Rheumatology (Oxford).
2009;
48
5-10
46
Mirza S K, Deyo R A.
Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative
care for treatment of chronic back pain.
Spine (Phila Pa 1976).
2007;
32
816-823
47
Panjabi M M.
A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control
dysfunction.
Eur Spine J.
2006;
15
668-676
Dr. Gabriele Salomonowitz, MAS, MBA
Radiologietechnologie FH-Campus Wien
Favoritenstraße 226
1100 Wien
Österreich
Phone: +43/6 99 11 71 35 89
Fax: +43/16 06 68 77 48 09
Email: gabriele.salomonowitz@fh-campuswien.ac.at