Definition und Pathophysiologie neuropathischer Schmerzen

Zusammenfassung

Unser wissenschaftliches Verständnis von der Pathophysiologie neuropathischer Schmerzen hat sich in den letzten zwei Dekaden elementar erweitert. Hieraus ergab sich nicht zuletzt die Notwendigkeit, die 1994 formulierte Begriffsdefinition vom „Neuropathischen Schmerz“ weiter zu präzisieren und besser von Schmerzsyndromen anderweitigen pathophysiologischen Ursprungs abzugrenzen. Die von der NeuPSIG (Special Interest Group on Neuropathic Pain) erarbeitete, revidierte Definition vom neuropathischen Schmerz hat Eingang in die IASP-Taxonomie (International Association for the Study of Pain) gefunden, die in jeweils aktuellster Fassung über die Internetseite zugänglich ist (www.iasppain.org). Zudem wurde von der NeuPSIG ein diagnostisches Stufenschema entwickelt, an-hand dessen neuropathische Schmerzsyndrome nach ihrer diagnostischen Wahrscheinlichkeit klassifiziert werden können. In dem vorliegenden Artikel soll die gültige Definition vom neuropathischen Schmerz diskutiert und der neu entwickelte diagnostische Algorithmus zur Einordnung neuropathischer Schmerzsyndrome – auf der Grundlage der aktuellen Schmerzterminologie – vorgestellt werden. Darüber hinaus wird ein Überblick über die pathophysiologischen Grundlagen gegeben.

Summary

Over the past two decades, our knowledge regarding the pathophysiology of neuropathic pain has substantially changed. In light of growing insights into the complex patho-physiological mechanisms, the Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a redefinition of the term “neuropathic pain” in order to distinguish it more precisely from nociceptive pain or other pain syndromes. This redefined term was finally integrated in the IASP Taxonomy, of which the respective up to date version is published in the Internet (www.iasp-pain.org). Moreover, the NeuPSIG proposed a grading scheme which enables the clinician to classify neuropathic pain syndromes according to certainty of the diagnosis. Based on the current IASP Basic Pain Terminology, this article will present the definition and classification of neuropathic pain syndromes and will give an overview on current concepts regarding the underlying pathophysiology.

Schlüsselwörter

Nozizeptor - neuropathischer Schmerz - Hyper-algesie - Allodynie

Keywords

Nociceptor - neuropathic pain - hyperalgesia - allodynia

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