Psychotherapie in der interdisziplinären multimodalen Schmerztherapie: Update

Zusammenfassung

Psychotherapie bei chronischen Schmerzen? Was auf den ersten Blick unpassend erscheint, entpuppt sich als hilfreiche und wirksame Intervention für Störungsbilder, bei denen rein somatisch orientierte Behandlungsversuche scheitern. Eingebettet in die interdisziplinäre multimodale Schmerztherapie stellt die Schmerzpsychotherapie heutzutage einen essenziellen Bestandteil der Behandlung chronischer Schmerzen dar.

Abstract

Interdisciplinary multimodal pain therapy (IMPT) is based on the biopsychosocial model of pain and describes an integrated treatment for patients with chronic pain. IMPT incorporates a close cooperation of different disciplines, including physicians, psychotherapists, physiotherapists, and others. IMPT mainly aims to restore and increase patientsʼ physical, social and psychological functional capacity. The efficacy of IMPT has been evidenced by systematic reviews and meta-analyses. A number of studies further indicate IMPTʼs cost-efficiency. Psychotherapy is an essential component of IMPT. Its main goal within the framework of IMPT is to identify and modify dysfunctional patterns of pain coping, and to diagnose and potentially treat psychological comorbidities. Pain psychotherapy comprises mostly cognitive-behavioral interventions which address dysfunctional coping at the three levels of the pain experience (i.e., cognitive, emotional, and behavioral). Research into the efficacy of pain psychotherapy is rather sparse and studies have mostly focused on chronic back pain, yet existing results show promising evidence both for psychotherapy within IMPT and for psychotherapy as a monotherapy. This paper aims at providing an overview of (a) commonly employed cognitive-behavioral psychotherapeutic approaches and strategies in the treatment of chronic pain, and (b) the existing empirical evidence of pain psychotherapy both within the framework of IMPT and as a monotherapy. Future research should include a wider range of pain diagnoses and also investigate the potential benefit of individually-tailored treatments.

Kernaussagen

• Die Schmerzpsychotherapie bzw. die Beteiligung von PsychotherapeutInnen ist integraler Bestandteil der IMST und zumeist kognitiv-verhaltenstherapeutisch orientiert.

• Hauptziele der Schmerzpsychotherapie sind Erfassung und Veränderung bestehender dysfunktionaler Muster der Schmerzbewältigung sowie Diagnostik und ggf. Behandlung psychischer Komorbiditäten.

• In der Schmerzpsychotherapie werden Techniken angewandt, die sich auf alle Ebenen des Schmerzerlebens (Kognition, Emotion, Verhalten) beziehen.

• Funktionale Schmerzbewältigung umfasst hierbei unter anderem die Etablierung eines angepassten Aktivitätsniveaus, das Hinterfragen automatischer Gedanken und Überzeugungen, eine adäquate Emotionsregulation sowie die Anwendung von Entspannungs- und selbstregulativen Verfahren.

• Neuere Entwicklungen verlagern den Behandlungsfokus hin zu einer den Schmerz annehmenden Haltung, welche die Notwendigkeit betont, sich so gut wie möglich mit den bestehenden Schmerzen zu arrangieren.

• Der Einbezug von Schmerzpsychotherapie in der IMST scheint wesentlich zu sein für einen langfristigen Behandlungserfolg.

Schlüsselwörter

Interdisziplinäre multimodale Schmerztherapie (IMST) - chronischer Schmerz - Schmerzpsychotherapie - Wirksamkeit

Key words

Interdisciplinary multimodal pain therapy - chronic pain - psychological pain therapy - efficacy

Publikationsverlauf

Artikel online veröffentlicht:
11. September 2020

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