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Evidenzbasierte Interventionen zur Behandlung von chronischem Schmerz im unteren Rücken – Therapieauswahl für einen personalisierten Behandlungsansatz

Deutsche Fassung

Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach

German version

  • Pain clinical updates
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Zusammenfassung

Hintergrund

Chronischer Schmerz im unteren Rücken („chronic low back pain“ [cLBP]) hat in den Vereinigten Staaten und auch weltweit eine hohe Prävalenz. Er führt zu funktioneller Beeinträchtigung und verringert die Lebensqualität. Während für cLBP viele Therapien verfügbar sind, liegen wenige Informationen darüber vor, welche spezifische Therapie bzw. welche spezifischen Therapien beim individuellen Patienten oder in einer Subgruppe von Patienten am besten wirkt bzw. wirken. Das Back Pain Research Consortium, ein Teilbereich der National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, wird eine kooperative klinische Studie durchführen, in der ein personalisierter medizinischer Algorithmus entwickelt werden soll, um die Wahl der Therapie durch Patienten und Behandler für Patienten mit cLBP zu optimieren.

Ziel

Hauptziele des vorliegenden Beitrags sind eine aktualisierte Übersicht zu evidenzbasierten cLBP-Interventionen und eine Beschreibung des Begutachtungs- und Auswahlprozesses für den Einschluss von Interventionen in die klinische Studie.

Methoden

Eine Arbeitsgruppe von cLBP-Experten prüfte und wählte Interventionen für den Einschluss in die klinische Studie aus. Primäre Beurteilungsmaße waren die Evidenzstärke und die Größe des Therapieeffekts. Soweit in der Literatur verfügbar wurden Wirkdauer, Anschlagzeit, Carry-over-Effekt, multimodale Wirksamkeit, Responder-Subgruppen und Evidenz für den Mechanismus des Therapieeffekts oder Biomarker berücksichtigt.

Schlussfolgerung

Die Arbeitsgruppe wählte vier maßgebende evidenzbasierte Therapien bei cLBP für die Testung in der klinischen Studie und für die Anwendung in der routinemäßigen klinischen Behandlung aus. Diese Therapien umfassen (1) die Gabe von Duloxetin, (2) Akzeptanz- und Commitment-Therapie, (3) eine klassifikationsbasierte Übungs- und manuelle Therapieintervention und (4) einen Selbstmanagementansatz. Der Evidenzlevel für einen Therapieeffekt war bei jeder dieser Interventionen moderat bis hoch, zudem stammen sie aus verschiedenen therapeutischen Klassen.

Abstract

Introduction

Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP.

Objective

The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial.

Methods

A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered.

Conclusion

The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.

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Förderung

Diese Forschungsarbeit wurde von der NIH HEAL Initiative der National Institutes of Health unterstützt (Förderkennzeichen U24AR076730). Für den Inhalt sind allein die Autoren verantwortlich. Er spiegelt nicht unbedingt die offizielle Sichtweise der National Institutes of Health bzw. der NIH HEAL Initiative wider.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA

    Matthew C. Mauck, Chloe E. Barton & Samuel A. McLean

  2. Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Aileen F. Aylward

  3. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Brandon Birckhead

  4. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Timothy Carey

  5. Department of Physical Therapy, Boston University, College of Health and Rehabilitation Sciences, Sargent, Boston, MA, USA

    Diane M. Dalton

  6. Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, Kalifornien, USA

    Aaron J. Fields

  7. Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA

    Julie Fritz

  8. Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA

    Afton L. Hassett & David A. Williams

  9. University of North Carolina at Chapel Hill, Collaborative Studies Coordinating Center, Chapel Hill, NC, USA

    Anna Hoffmeyer

  10. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Sara B. Jones

  11. Department of Family and Community Medicine, University of California San Francisco, San Francisco, Kalifornien, USA

    Wolf E. Mehling

  12. Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA

    Conor W. O’Neill & Patricia Zheng

  13. Department of Physical Therapy and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA

    Michael J. Schneider

  14. Departments of Anesthesiology and Perioperative Medicine and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Ajay D. Wasan

Authors
  1. Matthew C. Mauck
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  2. Aileen F. Aylward
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  3. Chloe E. Barton
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  4. Brandon Birckhead
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  5. Timothy Carey
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  6. Diane M. Dalton
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  7. Aaron J. Fields
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  8. Julie Fritz
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  9. Afton L. Hassett
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  10. Anna Hoffmeyer
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  11. Sara B. Jones
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  12. Samuel A. McLean
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  13. Wolf E. Mehling
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  14. Conor W. O’Neill
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  15. Michael J. Schneider
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  16. David A. Williams
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  17. Patricia Zheng
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  18. Ajay D. Wasan
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Corresponding author

Correspondence to Matthew C. Mauck.

Ethics declarations

Interessenkonflikt

D.A. Williams ist als Berater für Swing Therapeutics Inc. und Community Health Focus Inc. tätig. A.L. Hassett ist als Berater für Happify, Inc. tätig. M.C. Mauck, A.F. Aylward, C.E. Barton, B. Birckhead, T. Carey, D.M. Dalton, A.J. Fields, J. Fritz, A. Hoffmeyer, S.B. Jones, S.A. McLean, W.E. Mehling, C.W. O’Neill, M.J. Schneider, P. Zheng und A.D. Wasan geben an, dass kein Interessenkonflikt besteht.

Additional information

Hinweis des Verlags

Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

Deutsche Fassung von: Mauck MC, Aylward AF, Barton CE et al. (2022) Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach. Pain Clinical Updates in Pain Reports. PR9 7 (2022) e1019. https://doi.org/10.1097/PR9.0000000000001019. Publikation auf Deutsch mit Genehmigung der International Association for the Study of Pain und der Autoren. Verantwortlich: Prof. Dr. Claudia Sommer, Würzburg.

Aus Gründen der besseren Lesbarkeit wird in dieser Übersetzung das generische Maskulinum verwendet. Sämtliche Personenbezeichnungen gelten für alle Geschlechter.

Übersetzung

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Mauck, M.C., Aylward, A.F., Barton, C.E. et al. Evidenzbasierte Interventionen zur Behandlung von chronischem Schmerz im unteren Rücken – Therapieauswahl für einen personalisierten Behandlungsansatz. Schmerz (2024). https://doi.org/10.1007/s00482-024-00798-x

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  • DOI: https://doi.org/10.1007/s00482-024-00798-x

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