Pharmakologische und interventionelle Therapie des Komplexen regionalen Schmerzsyndroms (CRPS)

Zusammenfassung

Die Therapie des komplexen regionalen Schmerzsyndroms (CRPS) stellt in der täglichen Praxis aufgrund der Vielzahl und Schwere der Symptome (sensorisch, motorisch, autonom), die individuell unterschiedlich ausgeprägt sein können, eine Herausforderung dar. Erschwerend kommt hinzu, dass es kaum evidenzbasierte Therapiemöglichkeiten gibt, da die Datenlage zur Schmerztherapie beim CRPS schlecht ist. Zur Therapie des als eine Entität neuropathischer Schmerzen verstandenen Syndroms werden daher auch Studienergebnisse herangezogen, die an Patienten mit verschiedenen neuropathischen Schmerzsyndromen erhoben wurden. Bei der Therapie des CRPS wird nicht zwischen dem CRPS Typ I (ohne Nervenläsion) und CRPS Typ II (mit nachgewiesener Nervenläsion) unterschieden. Für eine optimale Therapie sollte eine multimodale und stadienorientierte Therapie eingeleitet werden, die sich an den klinischen Befunden, dem Verlauf und Schweregrad der Erkrankung orientiert. Diese sollte aus analgetischer Pharmakotherapie, ggf. anti-entzündlicher Therapie, interventioneller Therapie, Physio-/Ergotherapie und psychologischen Begleitverfahren (Schmerzcoping, Biofeedback, Verhaltenstherapie usw.) bestehen. Pharmakologische und interventionelle Therapieansätze werden vor dem Hintergrund einer möglichst evidenzbasierten Therapie näher beleuchtet.

Abstract

The treatment of complex regional pain syndrome (CRPS) remains challenging due to the individually distinct multitude and severity of sensory, autonomic and motor signs and symptoms. Additionally, only a few controlled studies on the therapy for CRPS have been conducted so far, limiting evidence-based treatment options. Frequently, results of studies on different neuropathic pain syndromes have been “transferred” for the treatment of CRPS. No differences are made in the treatment of CRPS type I (without a nerve lesion) and CRPS type II (with electrophysiological or other definite evidence of a major nerve lesion). An optimal treatment of CRPS should be multimodal and adjusted to the clinical signs and symptoms, progress and severity of the disease. It should include analgesics, anti-inflammatory pharmacological treatment if necessary, interventional therapy as well as physiotherapy/occupational therapy and psychological treatment (pain coping, biofeedback, behavioural therapy). Pharmacological and interventional treatment options in CRPS are discussed based on randomised controlled trials and the clinical experience of the authors.

Schlüsselwörter

Komplexes regionales Schmerzsyndrom - CRPS - neuropathischer Schmerz - Therapie - Sudeck'schen Dystrophie

Key words

complex regional pain syndrome - CRPS - neuropathic pain - treatment - Sudecks's dystrophy

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