Behandlung von chronischen Schmerzsyndromen – Die Spinal cord stimulation im Überblick

Die Spinal cord stimulation (SCS) stellt neben den konservativen Verfahren eine gute alternative Therapieoption bei einer Vielzahl von chronischen Schmerzsyndromen dar. Die häufigsten Indikationen für eine SCS sind das failed back surgery syndrome (FBSS) und das complex regional pain syndrome (CRPS), jedoch sind die Ergebnisse auch bei ischämischen Schmerzen wie der therapierefraktären Angina pectoris (AP) oder den Schmerzen bei der schweren peripheren arteriellen Verschlusskrankheit (pAVK) gut. Bei den beiden letztgenannten Indikationen konnte neben der Schmerzlinderung zudem eine erhöhte Durchblutung in den betroffenen Gliedmaßen gezeigt werden. Die Grundlagenforschung hat in den letzten Jahren das Wissen um den Wirkmechanismus um wichtige Informationen erweitert, sodass heutzutage vielfältige Veränderungen im Neurotransmittersystem für die analgetischen Effekte verantwortlich gemacht werden. Die Weiterentwicklung von Elektroden und Generatoren hat weiterhin die Möglichkeiten verbessert, die Komplikationen verringert und es erlaubt, präziser Einfluss auf die zu stimulierenden Strukturen im Rückenmark zu nehmen.

Spinal cord stimulation (SCS) is an excellent treatment modality in a broad range of chronic pain syndromes. Failed back surgery syndrome and complex regional pain syndrome represent the most common indications for spinal cord stimulation. Critical leg ischemia and therapeutically refractory angina pectoris are further indications for SCS, that not only reduce the pain, but also improve limb perfusion and therefore increasing the amount of limb salvage. Research during the last decades improved our knowledge about the principle mechanism, which is based on broad changes in neurotransmitters being responsible for the analgesic effect of the SCS. Further development in electrode configuration and generator improvement reduces the complication rate and improves the stimulation precision.

Key words

Chronic pain syndromes - failed back surgery syndromes - complex regional pain syndromes - spinal cord stimulation

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