Schmerzen bei osteoporotischen Frakturen im zeitlichen Verlauf

Zusammenfassung

Osteoporoseschmerzen sind Frakturschmerzen; zusätzlich bestehen Schmerzen durch die Irritation der die Wirbelsäule umgebenden Strukturen wie Bänder, Facettengelenke und Muskeln. Zur Schmerzquantifizierung und Überwachung des Erfolgs der therapeutischen Maßnahmen sollte eine Schmerzdokumentation erfolgen. Die Anwendung des WHO-Stufenschemas ist aufgrund der besonderen Ursache der Schmerzen und des meist fortgeschrittenen Alters der Patienten nur mit Einschränkungen möglich. Dagegen ist der Einsatz eines individuellen multimodalen Therapieschemas mit Einschluss medikamentöser, physikalischer und physiotherapeutischer Maßnahmen sowie geeigneter Orthesen notwendig, um den Patienten mobilisieren zu können. Bei trotz adäquater Therapie nicht beherrschbaren Schmerzen sollten auch eine Kyphoplastie/Vertebroplastie erwogen werden.

Summary

Osteoporotic pain is caused by the osteoporotic fractures; additionally there may be pain bei altered anatomic structures, e. g. myofascial pain in the surrounding of vertebral fractures. To quantify pain and to measure the effect of therapeutic interventions a VAS-pain score should be performed. The WHO pain ladder is regularly used in osteoporotic pain: however the nature of the osteoporotic pain and the advanced age of the patients limit the use of some substances of the WHO pain ladder. An individualized treatment plan including analgesic and physiotherapeutic measures should provide for optimal pain relief and early mobilization. Back bracing should support pain therapy. If pain cannot be controlled despite optimal conservative therapy balloon kyphoplasty or vertebroplasty should be considered.

Schlüsselwörter

Osteoporoseschmerz - Schmerztherapie - WHO-Stufenschma - Orthese

Keywords

Osteoporosis - pain therapy - WHO pain ladder - back bracing

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