Schmerzen bei Patienten mit chronischen Bewusstseinsstörungen

Zusammenfassung

Es gelang durch eine Reihe von Forschungsarbeiten die wenig verstandene und teilweise ignorierte Problematik von Schmerzen bei bewusstseinsgestörten Patienten ein Stück weit zu erhellen. Funktionelle Bildgebungsstudien zeigen, dass die früher definitionsgemäß erwartete vollkommende Unfähigkeit Schmerzen zu empfinden für Patienten mit einem Syndrom reaktionsloser Wachheit nicht generell zutrifft. Die Nociception Coma Scale versucht, die Schmerzwahrnehmung bewusstseinsgestörter Patienten zu objektivieren und deren Schmerztherapie zu verbessern. Allerdings kann diese Skala nur ansatzweise die Frage nach einer tatsächlich erhaltenen Schmerzwahrnehmung beantworten. Schmerztherapie sollte auch Patienten ohne äußere Anzeichen für Bewusstsein nicht vorenthalten werden. Allerdings muss die Sinnhaftigkeit einer solchen Therapie immer gut hinterfragt werden, um Nebenwirkungen der Medikation und Behinderung von Rehabilitationsfortschritten durch Sedierung zu vermeiden. Spastik stellt eine häufige potenzielle Schmerzursache bei schwer betroffenen neurologischen Patienten dar. Neben intrathekalem Baclofen bietet die Botulinumtoxininjektion eine relativ nebenwirkungsarme und wirkungsvolle Therapiealternative.

Summary

As a result of research work, the neglected problem of pain in patients with disorders of consciousness has been elucidated. So far it was believed that these patients are not able to perceive pain. Functional imaging caused a paradigm shift showing that cerebral pain processing is possible in some patients. The Nociception Coma Scale tries to objectify the pain perception of patients with disorders of consciousness and helps to improve their pain therapy. However, this scale can only provide an answer to the question of an acute pain perception. Pain therapy should not be withheld to patients without external signs of consciousness. However, the meaningfulness of such a therapy must always be questioned well in order to avoid side effects of the medication and obstruction of rehabilitation progress because of sedation. Spasticity is a common potential cause of pain in severely affected neurological patients. In addition to intrathecal baclofen, botulinum toxin injection offers a convenient therapy alternative.

Schlüsselwörter

Schmerz - Syndrom reaktionsloser Wachheit - minimal bewusstes Syndrom - fMRT

Keywords

Pain - unresponsive wakefulness state - minimal conscious state - fMRI

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