Abstract
Zusammenfassung. Die Therapie von Rückenschmerzen, speziell die medikamentöse Schmerztherapie mit Opioiden, führt bei der behandelnden Ärztin/beim behandelnden Arzt oft zum Dilemma. Spezifische Rückenschmerzen werden durch gezielte Bildgebung diagnostiziert und operativ oder medikamentös erfolgreich therapiert. Im Gegensatz dazu können bei nicht-spezifischen Rückenschmerzen unbegründete Bildgebung, zweifelhafte Operationsindikationen und unkontrollierte Medikamentengabe die Schmerzen verstärken. Hier ist die Aufrechterhaltung der Aktivität und die Bewegungstherapie zentral für die Therapie. Beim Einsatz von Opioiden verhält es sich ähnlich. Opioide sind potente Medikamente zur kurzfristigen Schmerztherapie. Langzeitanwendung kann die Schmerzen verstärken und Störungen im Hormonhaushalt mit Einschränkungen der Lebensqualität und Libido bewirken. Ausserdem haben Opioide ein Gewöhnungs- und Suchtpotenzial. Eine Opioidtherapie, wenn überhaupt, sollte nur nach frustraner Nicht-Opioid-Therapie, zeitlich begrenzt (möglichst kürzer als vier Wochen) und nach klaren Richtlinien erfolgen.
Abstract. The therapy of back pain – especially the medication with opioids – can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.
Résumé. La thérapie du mal de dos – en particulier la médication avec des opioïdes – peut être un défi pour le médecin traitant. Les douleurs dorsales spécifiques peuvent souvent être diagnostiquées par imagerie et traitées avec succès par chirurgie ou par médicaments. Par contraste, les douleurs dorsales non spécifiques peuvent être aggravées par une imagerie inappropriée, des indications chirurgicales douteuses et une utilisation incontrôlée des médicaments. Pour le traitement des douleurs dorsales non spécifiques, le maintien de l’activité quotidienne et la thérapie par l’exercice sont essentiels. Les opioïdes sont des médicaments efficaces à court terme. Cependant, l’utilisation à long terme entraîne souvent une hyperalgésie induite par les opioïdes et un dysfonctionnement hormonal avec une diminution de la qualité de vie et de la libido. En outre, les opioïdes peuvent entraîner un abus et une dépendance. Après un traitement inefficace avec des non-opioïdes, les opioïdes peuvent être administrés pendant une période limitée (si possible inférieure à quatre semaines), selon des directives claires.
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