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Nervenheilkunde 2012; 31(03): 125-131
DOI: 10.1055/s-0038-1628270
Schmerz
Schattauer GmbH

Screening und Diagnostik neuropathischer Schmerzen

Screening and diagnostic work-up of neuropathic pain
R. Rolke
1   Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn
,
L. Radbruch
1   Klinik und Poliklinik für Palliativmedizin, Universitätsklinikum Bonn
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Eingegangen am: 22. Mai 2011

angenommen am: 07. Juni 2011

Publikationsdatum:
23. Januar 2018 (online)

    Lizenzen und Reprints

Zusammenfassung

Das diagnostische „Work-up“ neuropathischer Schmerzen umfasst Schmerzfragebögen als Screening-Instrumente sowie eine Schmerzzeichnung, Informationen zur Krankheitsgeschichte und eine klinisch-neurologische Untersuchung zur Klärung der Fragen: Ist das Screening zur Ausprägung von Schmerzdeskriptoren vereinbar mit dem Vorliegen eines neuropathischen Schmerzes? Ist das Muster der Schmerzausbreitung und des sensiblen Defizits neuroanatomisch nachvollziehbar? Finden sich Hinweise auf eine relevante Läsion oder Erkrankung der peripheren oder zentralen Anteile des somatosensorischen Systems? Als Ergänzung zur elektrophysiologischen Untersuchung des somatosensorischen Systems hat sich als komplementäres Verfahren die quantitative sensorische Testung etabliert, die anders als konventionelle Verfahren neben sensiblen Defiziten die Erfassung sensibler Pluszeichen erlaubt. Klinische Pluszei-chen wie Hyperalgesie, Hyperpathie und Allodynie oder Minuszeichen wie Hypästhesie und Hypoalgesie können dabei auf dem Schmerz zugrunde liegende neurobiologische Mechanismen hinweisen, wie eine periphere, zentrale Sensibilisierung oder Deafferenzie-rung im nozizeptiven System.

Summary

The diagnostic work-up of neuropathic pain includes screening tools such as pain questionnaires and pain drawings as well as additional information of patients´ disease history and a clinical neurological examination to answer the questions: Is the screening for pain descriptors consistent with the existence of neuropathic pain? Is the pattern of pain distribution and sensory deficit neuroanatomically plausible? Is there a relevant lesion or disease affecting the peripheral or central parts of the somatosensory system? Quantitative sensory testing was established as extension of electrophysiological examination in the somatosensory system to allow testing for both gain and loss of sensory function in contrast to the conventional assessment of exclusively sensory loss. Sensory plus signs (hyperalgesia, hyperpathia and allodynia), or sensory minus signs (hypoesthesia and hypoalgesia) may point to possible underlying neurobiological pain mechanisms such as peripheral and central sensitization, or deafferentation in the nociceptive system.

Schlüsselwörter

Neuropathischer Schmerz - Schmerzfragebogen - painDETECT - LANSS - DN4 - NPQ - QST - quantitative sensorische Testung

Keywords

Neuropathic pain - pain questionnaire - painDETECT - LANSS - DN4 - NPQ - QST - quantitative sensory testing
 

  • Literatur

  • 1 Hansson P, Haanpaa M. Diagnostic work-up of neuropathic pain: computing, using questionnaires or examining the patient?. Eur J Pain 2007; 11 (04) 367-9.
    CrossrefPubMedGoogle Scholar
  • 2 Attal N. Screening tools for neuropathic pain: are they adaptable in different languages and cultures?. Pain Med 2010; 11 (07) 985-6.
    CrossrefPubMedGoogle Scholar
  • 3 Bennett MI. et al. Using screening tools to identify neuropathic pain. Pain 2007; 127 (03) 199-203.
    CrossrefPubMedGoogle Scholar
  • 4 Freynhagen R, Baron R, Gockel U, Tolle TR. pain-DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006; 22 (10) 1911-20.
    CrossrefPubMedGoogle Scholar
  • 5 Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 1999; 353 9168 1959-64.
    CrossrefPubMedGoogle Scholar
  • 6 Jensen TS, Baron R. Translation of symptoms and signs into mechanisms in neuropathic pain. Pain 2003; 102 1–2 1-8.
    CrossrefPubMedGoogle Scholar
  • 7 Rolke R. Diagnostic Work-up of neuropathic pain in clinical practice: Quantitative sensory testing complementary to conventional electrophysiology. Klin Neurophysiol 2009; 40 (03) 177-82.
    Artikel in Thieme ConnectGoogle Scholar
  • 8 Rolke R. et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 2006; 123 (03) 231-43.
    CrossrefPubMedGoogle Scholar
  • 9 Geber C. et al. Numbness in clinical and experimental pain – a cross-sectional study exploring the mechanisms of reduced tactile function. Pain 2000; 139 (01) 73-81.
    Google Scholar
  • 10 Magerl W, Treede RD. Secondary tactile hypoesthesia: a novel type of pain-induced somatosensory plasticity in human subjects. Neurosci Lett 2004; 361 1–3 136-9.
    CrossrefPubMedGoogle Scholar
  • 11 Baron R, Tolle TR. Assessment and diagnosis of neuropathic pain. Curr Opin Support Palliat Care 2008; 2 (01) 1-8.
    CrossrefPubMedGoogle Scholar
  • 12 Baumgartner U. [Nociceptive system: Nociceptors, fiber types, spinal pathways, and projection areas]. Schmerz 2010; 24 (02) 105-13.
    CrossrefPubMedGoogle Scholar
  • 13 Klein T, Magerl W, Rolke R, Treede RD. Human surrogate models of neuropathic pain. Pain 2005; 115 (03) 227-33.
    CrossrefPubMedGoogle Scholar
  • 14 Treede RD, Magerl W. Multiple mechanisms of secondary hyperalgesia. Prog Brain Res 2000; 129: 331-41.
    PubMedGoogle Scholar
  • 15 Rolke R. et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain 2006; 10 (01) 77-88.
    CrossrefPubMedGoogle Scholar
  • 16 Cruccu G. et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol 2010; 17 (08) 1010-8.
    CrossrefPubMedGoogle Scholar
  • 17 Haanpaa M. et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011; 152 (01) 14-27.
    CrossrefPubMedGoogle Scholar
  • 18 Namer B, Barta B, Orstavik K, Schmidt R, Carr R, Schmelz M. et al. Microneurographic assessment of C-fibre function in aged healthy subjects. J Physiol 2009; 587 Pt 2 419-28.
    CrossrefPubMedGoogle Scholar
  • 19 Serra J. Microneurography: an opportunity for translational drug development in neuropathic pain. Neurosci Lett 2010; 470 (03) 155-7.
    CrossrefPubMedGoogle Scholar
  • 20 Treede RD, Lorenz J, Baumgartner U. Clinical usefulness of laser-evoked potentials. Neurophysiol Clin 2003; 33 (06) 303-14.
    CrossrefPubMedGoogle Scholar
  • 21 Chen AC, Niddam DM, Arendt-Nielsen L. Contact heat evoked potentials as a valid means to study nociceptive pathways in human subjects. Neurosci Lett 2001; 316 (02) 79-82.
    CrossrefPubMedGoogle Scholar
  • 22 Obermann M. et al. Correlation of epidermal nerve fiber density with pain-related evoked potentials in HIV neuropathy. Pain 2008; 138 (01) 79-86.
    CrossrefPubMedGoogle Scholar
  • 23 Agostinho CM. et al. Habituation and short-term repeatability of thermal testing in healthy human subjects and patients with chronic non-neuropathic pain. Eur J Pain 2009; 13 (08) 779-85.
    CrossrefPubMedGoogle Scholar
  • 24 Hansson P, Backonja M, Bouhassira D. Usefulness and limitations of quantitative sensory testing: clinical and research application in neuropathic pain states. Pain 2007; 129 (03) 256-9.
    CrossrefPubMedGoogle Scholar
  • 25 Rolke R. (ed.). Diagnostic work-up of neuropathic pain in clinical practice: From bedside clinical examination to quantitative sensory testing. 2nd ed. Oxford: Oxford University Press; 2009
    Google Scholar
  • 26 Loeser JD, Treede RD. The Kyoto protocol of IASP Basic Pain Terminology. Pain 2008; 137 (03) 473-7.
    CrossrefPubMedGoogle Scholar