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Konzept zur integrativen Schmerztherapie bei Gonarthrose unter Beachtung der Evidenz konservativer und komplementärer Verfahren

Concept for integrative pain treatment of osteoarthritis of the knee based on the evidence for conservative and complementary therapies

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Zusammenfassung

Hintergrund

Die Gonarthrose stellt eine medizinische Herausforderung dar.

Fragestellung

Wie ist die Evidenzlage in Bezug auf komplementäre Verfahren und deren Integration in die multimodale Schmerztherapie?

Material und Methoden

Qualitative, nichtsystematische Recherche zu Epidemiologie, physiologischen Mechanismen sowie aussagekräftigen klinischen Studien, Metaanalysen und Leitlinien zur konservativen Therapie inklusive ausgewählter komplementärmedizinischer Verfahren

Ergebnisse

Gonarthrose ist eine häufige Erkrankung mit biopsychosozialen Chronifizierungsfaktoren. Die S2k-Leitlinie (k = Expertenkonsens, nicht wissenschaftlich systematisch) der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) von 2017 wurde bisher nicht aktualisiert. Die Leitlinie des American College of Rheumatology (ACR) datiert von 2020. Gemeinsam sind Empfehlungen in unterschiedlicher Abstufung zu Bewegungstherapie, Gewichtsreduktion, kurzfristiger Analgetikagabe, topischen Therapien, intraartikulärer Kortisoninjektion und Akupunktur. Darüber hinaus finden sich Kann-Empfehlungen für transkutane elektrische Nervenstimulation (TENS), Lasertherapie, elektrophysikalische Therapien, Stoßwellentherapie, Traktionsbehandlung, Ergotherapie, Wickel mit Beinwell und Schlammpackungen. Aktuelle Studien stützen die Anwendung von Tai-Chi/Qigong und Blutegeln.

Schlussfolgerung

Komplementäre Verfahren wie Akupunktur, Tai-Chi/Qigong, topische naturheilkundliche Selbstanwendungen und der Einsatz von Blutegeln (mit Einschränkung) können neben Verhaltensänderungen, Bewegungstherapie und kurzfristiger medikamentöser Therapie evidenzbasierte Bausteine eines integrativen Schmerztherapiekonzepts bei Gonarthrose im Sinne der interdisziplinären multimodalen Schmerztherapie sein. Sie bieten neben einer Verbesserung von Schmerz und Funktion zusätzliche Konzepte zum Selbstüben und zur Selbstbehandlung und können somit die interne Kontrollüberzeugung verbessern.

Abstract

Background

Osteoarthritis of the knee (gonarthritis) represents a medical challenge.

Research question

What is the evidence with respect to approaches of complementary medicine and their integration into multimodal pain management concepts?

Material and methods

Qualitative nonsystematic literature search on the epidemiology and pathophysiology as well as informative clinical trials, meta-analyses and clinical guidelines about conservative treatment including complementary therapy for gonarthritis.

Results

Osteoarthritis of the knee is a frequent condition with biopsychosocial risks factors for chronification. The German S2k clinical guideline (k = consensus-based, not based on scientific systematic literature searches) published by the Association of the Scientific Medical Societies in Germany (AWMF) in 2017 has not yet been updated. The current guidelines of the American College of Rheumatology (ACR) date from 2020. Both guidelines recommend exercise therapy, weight reduction, short-term analgesics, topical therapy, intra-articular corticoid injections and acupuncture with variable strengths. Furthermore, transcutaneous electrical nerve stimulation (TENS), laser and other electrophysical therapies, shock waves, traction treatment, ergotherapy, comfrey poultices and mudpacks can also be used. Current research supports the benefits of tai chi/qigong and medicinal leaches.

Conclusion

Complementary treatment approaches, such as acupuncture, tai chi/qigong, topical naturopathic self-treatment and leeches (with limitations) can, in addition to behavioral changes, exercise therapy and short-term pharmacological treatment, be important evidence-based components of integrative pain management concepts, e.g. in terms of an interdisciplinary multimodal pain treatment (IMPT). Besides pain reduction and functional improvement they promote the internal control conviction through the possibility of self-treatment and self-exercise.

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  1. Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, LMU München, Campus Innenstadt, Pettenkoferstr. 8a, 80336, München, Deutschland

    Dominik Irnich &  Petra Bäumler

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  1. Dominik Irnich
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Correspondence to Dominik Irnich.

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D. Irnich ist erster Vorsitzender und P. Bäumler Mitglied des Wissenschaftszentrums der Deutschen Ärztegesellschaft für Akupunktur e. V. (gemeinnützige Fachgesellschaft). D. Irnich und P. Bäumler erhalten Unkosten- sowie Reisekostenerstattungen für Lehr- und Vortragstätigkeiten an Universitäten und gemeinnützigen Vereinen. Beide Autoren sind Mitglied der Deutschen Schmerzgesellschaft e. V. und der International Association for the Study of Pain (IASP) sowie weiterer gemeinnütziger Fachverbände. Verbindungen zu Organisationen mit wirtschaftlichem Interesse bestehen nicht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Irnich, D., Bäumler, P. Konzept zur integrativen Schmerztherapie bei Gonarthrose unter Beachtung der Evidenz konservativer und komplementärer Verfahren. Schmerz 37, 413–425 (2023). https://doi.org/10.1007/s00482-023-00739-0

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