Mattenklodt Peter, Ingenhorst Anne, Flatau Brigitta, Becker Kristina, Grießinger Norbert
Schmerzzentrum, Uniklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
medi train - Bewegungstherapie Physiotherapie, Erlangen, Deutschland.
Anaesthesiologie. 2024 Mar;73(3):147-155. doi: 10.1007/s00101-024-01392-7.
Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.
老年人的慢性疼痛问题日益凸显，且会对健康产生严重影响。因此，国际指南要求，老年人的疼痛治疗最好采用基于生物 - 心理 - 社会疼痛模型的多模式疗法。有专门的心理测量测试和访谈指南用于跨学科疼痛评估。多模式疼痛疗法对老年人有效性的证据仍然有限。然而，对照临床试验表明，这些患者能从中受益，尤其是当干预措施适应他们的特定需求时。运动疗法的重点不仅在于增强肌肉力量，还包括协调性训练。在个体物理治疗和职业治疗中，可以针对老年人中更常见的个体身体限制制定日常解决方案。在心理训练中，疼痛接纳、平衡休息与活动、社会融入以及应对衰老都是特别重要的主题。放松和正念技巧也能对疼痛和功能产生积极影响。因此，这些方法很受患者欢迎，并且常在日常疼痛管理中采用。疼痛教育被认为是一种有用的辅助措施，在老年人中也越来越多地得到数字媒体的支持。补充治疗成分包括对抗恐惧回避信念（德国的AMIKA量表，Ältere Menschen in körperlicher Aktion，即“身体行动中的老年人”）以及自然疗法应用作为一种积极的自助策略。由于尚不清楚所取得的治疗效果能持续多久，后续护理在老年患者的治疗中尤为重要。
