Was gibt es Neues beim neuropathischen Schmerz?

Zusammenfassung

In den beiden letzten Jahren haben sich zahlreiche neue Daten zur Diagnostik, Pathophysiologie und Therapie von neuropathischen Schmerzen ergeben. Diese Übersicht fasst aktuelle Ergebnisse aus der Forschung, aus Studien und aus Leitlinien zusammen. Themenschwerpunkte liegen auf der Pathophysiologie neuropathischer Schmerzen, sofern die Daten Bezug zur Klinik haben oder erwarten lassen, auf Leitlinien zur Diagnostik und neuen diagnostischen Methoden und auf kontrollierten Studien zu bekannten und innovativen Medikamenten. Es werden neue Studiendaten zu etablierten Substanzen wie Amitriptylin und Gabapentin berichtet sowie Studiendaten zu neuen Substanzen wie Lacosamid, Levetiracetam und zu topischen Therapien referiert. Zudem wird über neue Ergebnisse zu nicht medikamentösen Therapieformen wie der repetitiven transkraniellen Magnetstimulation, der Motorkortexstimulation und zu psychotherapeutischen Verfahren berichtet.

Abstract

This review summarises new developments concerning neuropathic pain during the last 2 years, including the latest results of basic research, clinical studies and guidelines. The article focuses on those pathophysiological studies with relevance for clinical treatment, on new guidelines and methods for defining neuropathic pain and the latest controlled studies concerning therapies for neuropathic pain. We report new data on established medications such as amitriptyline and gabapentin as well as data on novel therapies such as lacosamide, levetiracetam or topical therapies. In addition, new results on non-drug treatments such as repetitive transcranial magnetic stimulation, motor cortex-stimulation and psychotherapy are presented. The aim of this review is to provide a fast overview on the latest developments of neuropathic pain.

Schlüsselwörter

neuropathischer Schmerz - Schmerzdefinition - Schmerzdiagnostik - Schmerztherapie

Keywords

neuropathic pain - pain definition - diagnostics of neuropathic pain - pain therapy

Literatur

• 1 Treede R D, Jensen T S, Campbell J N. et al . Neuropathic pain: redefinition and a grading system for clinical and research purposes.  Neurology. 2008;  70 1630-1635
• 2 Cruccu G, Sommer C, Anand P. et al . EFNS guidelines on neuropathic pain assessment: revised 2009.  Eur J Neurol. 2010;  17 1010-1018
• 3 Maier C, Baron R, Tolle T R. et al . Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes.  Pain. 2010;  150 439-450
• 4 Baron R, Tolle T R, Gockel U. et al . A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: Differences in demographic data and sensory symptoms.  Pain. 2009;  146 34-40
• 5 Blankenburg M, Boekens H, Hechler T. et al . Reference values for quantitative sensory testing in children and adolescents: developmental and gender differences of somatosensory perception.  Pain. 2010;  149 76-88
• 6 Truini A, Panuccio G, Galeotti F. et al . Laser-evoked potentials as a tool for assessing the efficacy of antinociceptive drugs.  Eur J Pain. 2010;  14 222-225
• 7 Truini A, Biasiotta A, Cesa S L. et al . Mechanisms of pain in distal symmetric polyneuropathy: A combined clinical and neurophysiological study.  Pain. 2010;  150 516-521
• 8 Mueller D, Obermann M, Koeppen S. et al . Electrically evoked nociceptive potentials for early detection of diabetic small-fiber neuropathy.  Eur J Neurol. 2010;  17 834-841
• 9 Obermann M, Katsarava Z, Esser S. et al . Correlation of epidermal nerve fiber density with pain-related evoked potentials in HIV neuropathy.  Pain. 2008;  138 79-86
• 10 Warbrick T, Derbyshire S W, Bagshaw A P. Optimizing the measurement of contact heat evoked potentials.  J Clin Neurophysiol. 2009;  26 117-122
• 11 Bickel A, Heyer G, Senger C. et al . C-fiber axon reflex flare size correlates with epidermal nerve fiber density in human skin biopsies.  J Peripher Nerv Syst. 2009;  14 294-299
• 12 Devigili G, Tugnoli V, Penza P. et al . The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology.  Brain. 2008;  131 1912-1925
• 13 Scherens A, Maier C, Haussleiter I S. et al . Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities.  Eur J Pain. 2009;  13 711-718
• 14 Bednarik J, Vlckova-Moravcova E, Bursova S. et al . Etiology of small-fiber neuropathy.  J Peripher Nerv Syst. 2009;  14 177-183
• 15 Tavakoli M, Quattrini C, Abbott C. et al . Corneal confocal microscopy: a novel noninvasive test to diagnose and stratify the severity of human diabetic neuropathy.  Diabetes Care. 2010;  33 1792-1797
• 16 Gemignani F, Ferrari G, Vitetta F. et al . Non-length-dependent small fibre neuropathy. Confocal microscopy study of the corneal innervation.  J Neurol Neurosurg Psychiatry. 2010;  81 731-733
• 17 Cauda F, D'Agata F, Sacco K. et al . Altered resting state attentional networks in diabetic neuropathic pain.  J Neurol Neurosurg Psychiatry. 2010;  81 806-811
• 18 Stoll G, Bendszus M, Perez J. et al . Magnetic resonance imaging of the peripheral nervous system.  J Neurol. 2009;  256 1043-1051
• 19 Pham M, Sommer C, Wessig C. et al . Magnetic resonance neurography for the diagnosis of extrapelvic sciatic endometriosis.  Fertil Steril. 2010;  94 351, e11-4
• 20 Serra J. Microneurography: an opportunity for translational drug development in neuropathic pain.  Neurosci Lett. 2010;  470 155-157
• 21 Serra J, Sola R, Quiles C. et al . C-nociceptors sensitized to cold in a patient with small-fiber neuropathy and cold allodynia.  Pain. 2009;  147 46-53
• 22 Namer B. Age related changes in human C-fiber function.  Neurosci Lett. 2010;  470 185-187
• 23 Campero M, Bostock H, Baumann T K. et al . A search for activation of C nociceptors by sympathetic fibers in complex regional pain syndrome.  Clin Neurophysiol. 2010;  121 1072-1079
• 24 Ciaramitaro P, Mondelli M, Logullo F. et al . Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients.  J Peripher Nerv Syst. 2010;  15 120-127
• 25 Pazzaglia C, Briani C, Orazio E N. et al . Occurrence and characterization of Pain in immune-mediated neuropathies: a multicentre prospective study.  Eur J Neurol. 2010, ePub 6/2010; 
• 26 Erdmann P G, van Genderen F R, Teunissen L L. et al . Pain in patients with chronic idiopathic axonal polyneuropathy.  Eur Neurol. 2010;  64 58-64
• 27 Martinez V, Fletcher D, Martin F. et al . Small fibre impairment predicts neuropathic pain in Guillain-Barre syndrome.  Pain. 2010;  151 53-60
• 28 Taylor K S, Anastakis D J, Davis K D. Chronic pain and sensorimotor deficits following peripheral nerve injury.  Pain. 2010, Epub 7 / 2010; 
• 29 Sommer C. When does nerve injury hurt?.  Pain. 2010, Epub 7 / 2010; 
• 30 Gao Y J, Ji R R. Chemokines, neuronal-glial interactions, and central processing of neuropathic pain.  Pharmacol Ther. 2010;  126 56-68
• 31 White F A, Miller R J. Insights into the regulation of chemokine receptors by molecular signaling pathways: functional roles in neuropathic pain.  Brain Behav Immun. 2010;  24 859-865
• 32 Sommer C, White F A. Cytokines, chemokines, and pain. In: Beaulieu P, Lussier D, Porreca F, Dickenson AH, eds Pharmacology of Pain. Seattle; IASP Press 2010: 279-302
• 33 Üçeyler N, Rogausch J P, Toyka K V. et al . Differential expression of cytokines in painful and painless neuropathies.  Neurology. 2007;  69 42-49
• 34 Doupis J, Lyons T E, Wu S. et al . Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy.  J Clin Endocrinol Metab. 2009;  94 2157-2163
• 35 Üçeyler N, Kafke W, Riediger N. et al . Elevated proinflammatory cytokine expression in affected skin in small fiber neuropathy.  Neurology. 2010;  74 1806-1813
• 36 Xu Z Z, Zhang L, Liu T. et al . Resolvins RvE1 and RvD1 attenuate inflammatory pain via central and peripheral actions.  Nat Med. 2010;  16 592-597, 1p following 7
• 37 Sommer C, Birklein F. Fighting off pain with resolvins.  Nat Med. 2010;  16 518-520
• 38 Maeda T, Kiguchi N, Kobayashi Y. et al . Leptin derived from adipocytes in injured peripheral nerves facilitates development of neuropathic pain via macrophage stimulation.  Proc Natl Acad Sci U S A. 2009;  106 13076-13081
• 39 Guneli E, Onal A, Ates M. et al . Effects of repeated administered ghrelin on chronic constriction injury of the sciatic nerve in rats.  Neurosci Lett. 2010;  479 226-230
• 40 Acharjee S, Noorbakhsh F, Stemkowski P L. et al . HIV-1 viral protein R causes peripheral nervous system injury associated with in vivo neuropathic pain.  FASEB J. 2010;  24 4343-4353
• 41 Fischer T Z, Waxman S G. Familial pain syndromes from mutations of the NaV1.7 sodium channel.  Ann N Y Acad Sci. 2010;  1184 196-207
• 42 Han C, Dib-Hajj S D, Lin Z. et al . Early- and late-onset inherited erythromelalgia: genotype-phenotype correlation.  Brain. 2009;  132 1711-1722
• 43 Fischer T Z, Gilmore E S, Estacion M. et al . A novel Nav1.7 mutation producing carbamazepine-responsive erythromelalgia.  Ann Neurol. 2009;  65 733-741
• 44 Reimann F, Cox J J, Belfer I. et al . Pain perception is altered by a nucleotide polymorphism in SCN9A.  Proc Natl Acad Sci U S A. 2010;  107 5148-5153
• 45 Costigan M, Belfer I, Griffin R S. et al . Multiple chronic pain states are associated with a common amino acid-changing allele in KCNS1.  Brain. 2010;  133 2519-2527
• 46 Attal N, Cruccu B, Baron R. et al . EFNS guidelines on the pharmacological treatment of neuropathic pain: 2009 revision.  Eur J Neurol. 2009;  17 1010-1018
• 47 Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment.  Lancet Neurol. 2010;  9 807-819
• 48 Bansal D, Bhansali A, Hota D. et al . Amitriptyline vs. pregabalin in painful diabetic neuropathy: a randomized double blind clinical trial.  Diabet Med. 2009;  26 1019-1026
• 49 Navarro A, Saldana M T, Perez C. et al . Patient-reported outcomes in subjects with neuropathic pain receiving pregabalin: evidence from medical practice in primary care settings.  Pain Med. 2010;  11 719-731
• 50 Simpson D M, Schifitto G, Clifford D B. et al . Pregabalin for painful HIV neuropathy: a randomized, double-blind, placebo-controlled trial.  Neurology. 2010;  74 413-420
• 51 Zin C S, Nissen L M, O'Callaghan J P. et al . A randomized, controlled trial of oxycodone versus placebo in patients with postherpetic neuralgia and painful diabetic neuropathy treated with pregabalin.  J Pain. 2010;  11 462-471
• 52 Gatti A, Sabato A F, Occhioni R. et al . Controlled-release oxycodone and pregabalin in the treatment of neuropathic pain: results of a multicenter Italian study.  Eur Neurol. 2009;  61 129-137
• 53 Gilron I, Bailey J M, Tu D. et al . Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial.  Lancet. 2009;  374 1252-1261
• 54 Quilici S, Chancellor J, Lothgren M. et al . Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain.  BMC Neurol. 2009;  9 6
• 55 Ziegler D, Hidvegi T, Gurieva I. et al . Efficacy and safety of lacosamide in painful diabetic neuropathy.  Diabetes Care. 2010;  33 839-841
• 56 Rossi S, Mataluni G, Codeca C. et al . Effects of levetiracetam on chronic pain in multiple sclerosis: results of a pilot, randomized, placebo-controlled study.  Eur J Neurol. 2009;  16 360-366
• 57 Finnerup N B, Grydehoj J, Bing J. et al . Levetiracetam in spinal cord injury pain: a randomized controlled trial.  Spinal Cord. 2009;  47 861-867
• 58 Yuan R Y, Sheu J J, Yu J M. et al . Botulinum toxin for diabetic neuropathic pain: a randomized double-blind crossover trial.  Neurology. 2009;  72 1473-1478
• 59 Cohen S P, Bogduk N, Dragovich A. et al . Randomized, double-blind, placebo-controlled, dose-response, and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica.  Anesthesiology. 2009;  110 1116-1126
• 60 Üçeyler N, Eberle T, Rolke R. et al . Differential expression patterns of cytokines in complex regional pain syndrome.  Pain. 2007;  132 195-205
• 61 Alexander G M, van Rijn M A, van Hilten J J. et al . Changes in cerebrospinal fluid levels of pro-inflammatory cytokines in CRPS.  Pain. 2005;  116 213-219
• 62 Huygen F J, De Bruijn A G, De Bruin M T. et al . Evidence for local inflammation in complex regional pain syndrome type 1.  Mediators of inflammation. 2002;  11 47-51
• 63 Kohr D, Tschernatsch M, Schmitz K. et al . Autoantibodies in complex regional pain syndrome bind to a differentiation-dependent neuronal surface autoantigen.  Pain. 2009;  143 246-251
• 64 Goebel A, Baranowski A, Maurer K. et al . Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial.  Annals of internal medicine. 2010;  152 152-158
• 65 Rowbotham M C, Duan W R, Thomas J. et al . A randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of ABT-594 in patients with diabetic peripheral neuropathic pain.  Pain. 2009;  146 245-252
• 66 Simpson D M, Brown S, Tobias J. Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy.  Neurology. 2008;  70 2305-2313
• 67 Backonja M, Wallace M S, Blonsky E R. et al . NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomised, double-blind study.  Lancet Neurol. 2008;  7 1106-1112
• 68 Backonja M M, Malan T P, Vanhove G F. et al . NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomized, double-blind, controlled study with an open-label extension.  Pain Med. 2010;  11 600-608
• 69 Leung A, Donohue M, Xu R. et al . rTMS for suppressing neuropathic pain: a meta-analysis.  J Pain. 2009;  10 1205-1216
• 70 Lefaucheur J P, Drouot X, Cunin P. et al . Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain.  Brain. 2009;  132 1463-1471
• 71 Velasco F, Carrillo-Ruiz J D, Castro G. et al . Motor cortex electrical stimulation applied to patients with complex regional pain syndrome.  Pain. 2009;  147 91-98
• 72 Humpert P M, Morcos M, Oikonomou D. et al . External electric muscle stimulation improves burning sensations and sleeping disturbances in patients with type 2 diabetes and symptomatic neuropathy.  Pain Med. 2009;  10 413-419
• 73 Gatchel R J. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective.  The American psychologist. 2004;  59 795-805
• 74 Scascighini L, Sprott H. Chronic nonmalignant pain: a challenge for patients and clinicians.  Nature clinical practice. 2008;  4 74-81
• 75 Turk D C, Swanson K S, Tunks E R. Psychological approaches in the treatment of chronic pain patients – when pills, scalpels, and needles are not enough.  Canadian journal of psychiatry. 2008;  53 213-223
• 76 Wetering E J, Lemmens K M, Nieboer A P. et al . Cognitive and behavioral interventions for the management of chronic neuropathic pain in adults – a systematic review.  Eur J Pain. 2010;  14 670-681