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Psychologische Faktoren im Kontext perioperativer Knie- und Gelenkschmerzen: die Rolle der Behandlungserwartungen für den Schmerzverlauf

Psychological factors in the context of perioperative knee and joint pain: the role of treatment expectations in pain evolvement

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Zusammenfassung

Chronische Knie- und Gelenkschmerzen stellen wie alle chronischen Schmerzen ein komplexes multidimensionales Geschehen dar, an dem gleichzeitig somatische, psychische und soziale Faktoren beteiligt sind. Patienten mit Knie- und anderen Gelenkschmerzen erleben sich in ihrem alltäglichen Leben, in ihrer beruflichen Tätigkeit, bei privaten Aktivitäten und in der Ausübung von sportlichen Freizeitaktivitäten eingeschränkt. Der Schmerz hindert sie zunehmend daran, ihre Ziele zu erreichen. Bei der Entwicklung und Aufrechterhaltung der Schmerzen spielen psychische Einflussfaktoren eine wichtige Rolle. Sie treten in Interaktion mit den am Schmerz beteiligten neurobiologischen und immunologischen Abläufen. Eine besondere Rolle spielen Erwartungen an den Krankheitsverlauf der Knie- und Gelenkschmerzen und Erwartungen an deren Behandlung. Studiendesigns, die eine Placeboknieoperation beinhalten, zeigen den hohen Einfluss dieser Variablen. Die Patienten, die eine Verumoperation erhalten, berichten nicht – wie erwartet – über weniger Schmerzen oder über eine bessere Funktionsfähigkeit als diejenigen, die eine Placebooperation erhalten. Der bedeutende Einfluss psychologischer Faktoren kann klinisch relevant genutzt werden. Eine positive Patienten-Behandler-Beziehung – geprägt durch Vertrauen, Wärme und Empathie – ist essenziell, um optimale therapeutische Wirksamkeit einer Behandlung zu erlangen. Jeder Operateur, Schmerzmediziner, Schmerzpsychologe oder Schmerzphysiotherapeut ist dafür verantwortlich, eine vertrauensvolle zwischenmenschliche Beziehung zwischen sich und dem Patienten zu gestalten.

Abstract

Chronic knee and joint pain, like all chronic pain, is a complex multidimensional event that involves somatic, psychological and social factors. Patients with knee and other joint pain experience limited mobility in their daily lives, in their professional and personal activities, and in their leisure physical exercise activities. Pain increasingly prevents them from achieving their goals. Psychological factors not only interact with neurobiological and immunological processes of pain, they play an important role in the development and maintenance of pain. Within that, expectations concerning the course of the disease and its treatment play a significant role. Study designs involving a placebo knee surgery show the high influence of these variables. The patients receiving the verum surgery do not report—as expected—less pain or better functioning than those receiving a placebo surgery. This significant influence of psychological factors may be clinically relevant. A positive patient–staff relationship—characterized by trust, warmth and empathy—is essential in order to achieve optimal therapeutic efficacy of a treatment. Every surgeon, pain physician, pain psychologist or pain physiotherapist is responsible for establishing a trusting interpersonal relationship between themselves and their patients.

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Gefördert durch die Deutsche Forschungsgemeinschaft (DFG): FOR 1328/1 to RK (Kl 1350/3-2).

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  1. Center for Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, Pain Therapy and Pain Psychology, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland

    R. Klinger PhD, J. Stuhlreyer, J. Schmitz & C. Zöllner

  2. Department for Trauma Surgery and Geriatric Trauma Care, Schön Clinic Hamburg Eilbek, Hamburg, 22081, Dehnhaide 120, Deutschland

    C. Roder & F. Krug

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R. Klinger erklärt, dass sie Gelder von der Deutschen Forschungsgemeinschaft (DFG) erhalten hat. Die DFG hat die vorliegende Arbeit nicht beeinflusst. R. Klinger, J. Stuhlreyer, J. Schmitz, C. Zöllner, C. Roder und F. Krug geben an, dass kein Interessenkonflikt besteht, der die vorliegende Arbeit beeinflusst hat.

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Klinger, R., Stuhlreyer, J., Schmitz, J. et al. Psychologische Faktoren im Kontext perioperativer Knie- und Gelenkschmerzen: die Rolle der Behandlungserwartungen für den Schmerzverlauf. Schmerz 33, 13–21 (2019). https://doi.org/10.1007/s00482-018-0350-2

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