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Zeitschrift für Komplementärmedizin 2020; 12(03): 32-37
DOI: 10.1055/a-1173-4194
Praxis
Hypersensitivität
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Der sensibilisierte Patient in der Schmerztherapie

Petra Bäumler∗
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Publication History

Publication Date:
26 June 2020 (online)

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Summary

Eine Gruppe von Patienten mit chronischen schmerzhaften Erkrankungen zeigen besonders viele unterschiedliche Symptome und ausgeprägte sensorische Sensibilisierungzeichen. Dieses Phänomen wird auch als Hypersensitivitätssyndrom beschrieben.

Aus neurophysiologischer lässt sich dies durch komplexe Sensibilisierungsmechanismen auf Ebene des Rückenmarks und des Gehrins erklären. Gleichsam entscheidend ist die seelische Sensibilisierung – psychische Erkrankungen und negative Affekte, wie eine katastrophisierende Haltung, Ängste und eine depressive Stimmungslage.

Intensive Forschungsarbeit hat gezeigt, dass neurophysiologische und psychologische Faktoren eng verwoben und nicht nur Folgen sondern auch Risikofaktoren für chronische schmerzhafte Erkrankungen sind.

In der Therapie sensibilisierter Patienten haben sich Verfahren bewährt, die den zugrunde liegenden neurophysiologischen Veränderungen entgegenwirken und sich gleichzeitig regulierend auf dysfunktionale Kognitionen, Emotionen und Verhaltensmuster auswirken. Dabei kommt der Komplementärmedizin eine große Bedeutung zu.

Keywords

Schmerztherapie - Sensibilisierung - Hypersensitivität - chronische Schmerzen - Neurophysiologie
 

  • Literatur

  • 1 Afari N, humada SM, Wright LJ. et al Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosom Med 2014; 76 (01) 2-11
    CrossrefPubMedSearch in Google Scholar
  • 2 Aggarwal VR, McBeth J, Zakrzewska JM. et al The epidemiology of chronic syndromes that are frequently unexplained: Do they have common associated factors?. Int J Epidemiol 2006; 35 (02) 468-476
    CrossrefPubMedSearch in Google Scholar
  • 3 Aoyagi K, He J, Nicol AL. A Subgroup of Chronic Low Back Pain Patients With Central Sensitization. Clin J Pain 2019; 35 (11) 869-879
    CrossrefPubMedSearch in Google Scholar
  • 4 Aron EN, Aron A, Davies KM. Adult shyness: The interaction of temperamental sensitivity and an adverse childhood environment. Pers Soc Psychol Bull 2005; 31 (02) 181-197
    CrossrefPubMedSearch in Google Scholar
  • 5 Baeumler PI, Conzen P, Irnich D. High Temporal Summation of Pain Predicts Immediate Analgesic Effect of Acupuncture in Chronic Pain Patients-A Prospective Cohort Study. Front Neurosci 2019; 13: 498
    CrossrefPubMedSearch in Google Scholar
  • 6 Creed F. Review article: The incidence and risk factors for irritable bowel syndrome in population-based studies. Aliment Pharmacol Ther 2019; 50 (05) 507-516
    CrossrefPubMedSearch in Google Scholar
  • 7 Edwards RR, Dworkin RH, Sullivan M. et al The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. J Pain 2016; 17 (Suppl. 09) T70-92
    CrossrefPubMedSearch in Google Scholar
  • 8 Egorova N, Gollub RL, Kong J. Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain. Neuroimage Clin 2015; 9: 430-435
    CrossrefPubMedSearch in Google Scholar
  • 9 Eller-Smith OC, Nicol AL, Christianson JA. Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions. Front Cell Neurosci 2018; 12: 35
    CrossrefPubMedSearch in Google Scholar
  • 10 Fillingim RB, Ohrbach R, Greenspan JD. et al Psychological factors associated with development of TMD: The OPPERA prospective cohort study. J Pain 2013; 14 (Suppl. 12) T75-90
    CrossrefPubMedSearch in Google Scholar
  • 11 Fox KC, Nijeboer S, Dixon M. et al Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci Biobehav Rev 2014; 43: 48-73
    CrossrefPubMedSearch in Google Scholar
  • 12 Gerhardt A, Eich W, Treede RD. Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia. Pain 2017; 158 (03) 430-439
    CrossrefPubMedSearch in Google Scholar
  • 13 Greenspan JD, Slade GD, Bair E. et al Pain sensitivity risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case control study. J Pain 2011; 12 (Suppl. 11) T61-74
    CrossrefPubMedSearch in Google Scholar
  • 14 Harris RE, Zubieta JK, Scott DJ. et al Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 2009; 47 (03) 1077-1085
    CrossrefPubMedSearch in Google Scholar
  • 15 Holley AL, Wilson AC, Palermo TM. Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: A prospective study. Pain 2017; 158 (05) 794-801
    CrossrefPubMedSearch in Google Scholar
  • 16 Horn-Hofmann C, Scheel J, Dimova V. et al Prediction of persistent post-operative pain: Pain-specific psychological variables compared with acute post-operative pain and general psychological variables. Eur J Pain 2018; 22 (01) 191-202
    CrossrefPubMedSearch in Google Scholar
  • 17 Irnich D, Bäumler P, Hanley K. Stand der Komplementärmedizin in Deutschland. Zeitschrift für Komplementärmedizin 2019; 11 (06) 14-25
    Thieme ConnectSearch in Google Scholar
  • 18 Irnich D. Was ist das Hypersensitivitätssyndrom?. Zeitschrift für Komplementärmedizin 2015; 6 (05) 1
    Search in Google Scholar
  • 19 Jones GT, Power C, Macfarlane GJ. Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British Birth Cohort Study. Pain 2009; 143 1-2 92-96
    CrossrefPubMedSearch in Google Scholar
  • 20 Kato K, Sullivan PF, Pedersen NL. Latent class analysis of functional somatic symptoms in a population-based sample of twins. J Psychosom Res 2010; 68 (05) 447-453
    CrossrefPubMedSearch in Google Scholar
  • 21 Kerr CE, Shaw JR, Wasserman RH. et al Tactile acuity in experienced Tai Chi practitioners: Evidence for use dependent plasticity as an effect of sensory-attentional training. Exp Brain Res 2008; 188 (02) 317-322
    CrossrefPubMedSearch in Google Scholar
  • 22 Khan RS, Ahmed K, Blakeway E. et al Catastrophizing: A predictive factor for postoperative pain. Am J Surg 2011; 201 (01) 122-131
    CrossrefPubMedSearch in Google Scholar
  • 23 Kramer S, Baeumler P, Geber C. et al Somatosensory profiles in acute herpes zoster and predictors of postherpetic neuralgia. Pain 2019; 160 (04) 882-894
    CrossrefPubMedSearch in Google Scholar
  • 24 Kuner R. Central mechanisms of pathological pain. Nat Med 2010; 16 (11) 1258-1266
    CrossrefPubMedSearch in Google Scholar
  • 25 Latremoliere A, Woolf CJ. Central sensitization: A generator of pain hypersensitivity by central neural plasticity. J Pain 2009; 10 (09) 895-926
    CrossrefPubMedSearch in Google Scholar
  • 26 Lin L, Skakavac N, Lin X. et al Acupuncture-Induced Analgesia: The Role of Microglial Inhibition. Cell Transplant 2016; 25 (04) 621-628
    CrossrefPubMedSearch in Google Scholar
  • 27 Lionetti F, Aron A, Aron EN. et al Dandelions, tulips and orchids: Evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals. Transl Psychiatry 2018; 8 (01) 24
    CrossrefPubMedSearch in Google Scholar
  • 28 Liss M, Timmel L, Baxley K. et al Sensory processing sensitivity and its relation to parental bonding, anxiety, and depression. Personality and Individual Differences 2005; 39 (08) 1429-1439
    CrossrefSearch in Google Scholar
  • 29 Maeda Y, Kim H, Kettner N. et al Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain 2017; 140 (04) 914-927
    CrossrefPubMedSearch in Google Scholar
  • 30 Malfliet A, Coppieters I, Van Wilgen P. et al Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review. Eur J Pain 2017; 21 (05) 769-786
    CrossrefPubMedSearch in Google Scholar
  • 31 Martinez-Calderon J, Zamora-Campos C, Navarro-Ledesma S. The Role of Self-Efficacy on the Prognosis of Chronic Musculoskeletal Pain: A Systematic Review. J Pain 2018; 19 (01) 10-34
    CrossrefPubMedSearch in Google Scholar
  • 32 Mills SEE, Nicolson KP, Smith BH. Chronic pain: A review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019; 123 (02) e273-e283
    CrossrefPubMedSearch in Google Scholar
  • 33 Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: A review. Neurorehabil Neural Repair 2012; 26 (06) 646-652
    CrossrefPubMedSearch in Google Scholar
  • 34 Nahman-Averbuch H, Nir RR, Sprecher E. et al Psychological Factors and Conditioned Pain Modulation: A Meta-Analysis. Clin J Pain 2016; 32 (06) 541-554
    CrossrefPubMedSearch in Google Scholar
  • 35 Nicholson RA, Houle TT, Rhudy JL. et al Psychological risk factors in headache. Headache 2007; 47 (03) 413-426
    PubMedSearch in Google Scholar
  • 36 O’Brien AT, Deitos A, Triñanes Pego Y. et al Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms. J Pain 2018; 19 (08) 819-836
    CrossrefPubMedSearch in Google Scholar
  • 37 Pincus T, Burton AK, Vogel S. et al A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976) 2002; 27 (05) E109-120
    CrossrefPubMedSearch in Google Scholar
  • 38 Rabey M, Slater H, OʼSullivan P. et al Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: A cluster analysis. Pain 2015; 156 (10) 1874-1884
    CrossrefPubMedSearch in Google Scholar
  • 39 Rice DA, Kluger MT, McNair PJ. et al Persistent postoperative pain after total knee arthroplasty: A prospective cohort study of potential risk factors. Br J Anaesth 2018; 121 (04) 804-812
    CrossrefPubMedSearch in Google Scholar
  • 40 Schaible HG, Ebersberger A, Natura G. Update on peripheral mechanisms of pain: Beyond prostaglandins and cytokines. Arthritis Res Ther 2011; 13 (02) 210
    CrossrefPubMedSearch in Google Scholar
  • 41 Staud R. Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions. Expert Rev Neurother 2012; 12 (05) 577-585
    CrossrefPubMedSearch in Google Scholar
  • 42 Treede RD. The role of quantitative sensory testing in the prediction of chronic pain. Pain 2019; 160 (Suppl. 01) 66-69
    CrossrefPubMedSearch in Google Scholar
  • 43 Tu Y, Ortiz A, Gollub RL. et al Multivariate resting-state functional connectivity predicts responses to real and sham acupuncture treatment in chronic low back pain. Neuroimage Clin 2019; 23: 101885
    CrossrefPubMedSearch in Google Scholar
  • 44 Vaegter HB, Graven-Nielsen T. Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity. Pain 2016; 157 (07) 1480-1488
    CrossrefPubMedSearch in Google Scholar
  • 45 Velly AM, Mohit S. Epidemiology of pain and relation to psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87 Pt B 159-167
    CrossrefPubMedSearch in Google Scholar
  • 46 Villemure C, Čeko M, Cotton VA. et al Neuroprotective effects of yoga practice: Age-, experience-, and frequency-dependent plasticity. Front Hum Neurosci 2015; 9: 281
    PubMedSearch in Google Scholar
  • 47 Wang L, Chang Y, Kennedy SA. et al Perioperative psychotherapy for persistent post-surgical pain and physical impairment: A meta-analysis of randomised trials. Br J Anaesth 2018; 120 (06) 1304-1314
    CrossrefPubMedSearch in Google Scholar
  • 48 Waxman SG, Zamponi GW. Regulating excitability of peripheral afferents: Emerging ion channel targets. Nat Neurosci 2014; 17 (02) 153-163
    Search in Google Scholar
  • 49 Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000; 288 5472 1765-1769
    CrossrefPubMedSearch in Google Scholar
  • 50 Yunus MB. Fibromyalgia and overlapping disorders: The unifying concept of central sensitivity syndromes. Semin Arthritis Rheum 2007; 36 (06) 339-356
    CrossrefPubMedSearch in Google Scholar
  • 51 Zamani M, Alizadeh-Tabari S, Zamani M. Systematic review with meta-analysis: The prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50 (02) 132-143
    CrossrefPubMedSearch in Google Scholar
  • 52 Zeidan F, Vago DR. Mindfulness meditation-based pain relief: A mechanistic account. Ann N Y Acad Sci 2016; 1373 (01) 114-127
    CrossrefPubMedSearch in Google Scholar