Die Pharmakotherapie neuropathischer Schmerzen - Individuell ausgerichtet, aber eingebettet in ein interdisziplinäres und multimodales Konzept

Trotz der Fortschritte der Schmerzforschung bilden Antidepressiva, Antikonvulsiva und lang wirksame Opioide nach wie vor die Basis jeder medikamentösen Therapie neuropathischer Schmerzen. Da einzelne neuropathische Krankheitsbilder keinen direkten Rückschluss auf die Wirksamkeit von Medikamenten im Allgemeinen bzw. spezieller Substanzen im Besonderen zulassen, müssen das bestmögliche Medikament oder die beste Kombination sowie die richtige Dosierung für jeden einzelnen Patienten zunächst durch Erprobung gefunden werden (individuelle Titration in Abhängigkeit von Wirkung und Nebenwirkungen). Eine zielgerichtete Therapie orientiert sich neben der zugrunde liegenden Schmerzentität und deren Symptomkonstellation insbesondere auch an den vielfach begleitenden Komorbiditäten wie Depression, Schlaf- und Angststörungen. Dabei muss eine differenzierte Pharmakotherapie immer auch in ein interdisziplinäres und multimodales Therapiekonzept eingebettet sein. Eine adäquate Schmerztherapie sollte so früh und so effektiv wie möglich eingeleitet werden, eine langfristige Therapiekontrolle ist unverzichtbar.

Despite the progress in pain research, antidepressants, anticonvulsants and long acting opioids still constitute the basis of any pharmacological treatment in neruopathic pain. Because the individual neuropathic conditions do not allow to draw direct conclusions regarding the efficacy of drugs in general or of specific drugs in particular, the best drug or best drug combinations including their appropriate doses must be found for the individual patient (individual dose titration considering efficacy and side effects). The goal of treatment addresses not only the underlying pain entity and its symptom constellation but also the improvement of comorbidities such as impaired mood, sleep, mobility, and physical functioning. It is emphasized that any individually tailored pharmacotherapy should be viewed within an interdisciplinary and multimodal treatment concept. Effective and timely analgesia at a therapeutic dose as well as long-term treatment follow-up are essential.

Key words

neuropathic pain - antidepressants - anticonvulsants - long acting opioids - individually tailored pharmacotherapy - multimodal treatment concept

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