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Nervenheilkunde 2017; 36(05): 324-331
DOI: 10.1055/s-0038-1627026
Schmerz
Schattauer GmbH

Mechanismenbasierte Therapie neuropathischer Schmerzen

Mechanism-based treatment of neuropathic pain
T. Mainka
1   Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf
,
C. Maier
2   Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinik Bergmannsheil GmbH, Ruhr-Universität Bochum
,
E. K. Enax-Krumova
3   Neurologische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinik Bergmannsheil GmbH, Ruhr-Universität Bochum
› Author Affiliations
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Publication History

eingegangen am: 25 October 2016

angenommen am: 10 November 2016

Publication Date:
20 January 2018 (online)

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Zusammenfassung

Neuropathische Schmerzen entstehen als direkte Folge einer Erkrankung oder Läsion des somatosensorischen Systems. In der Allgemeinbevölkerung haben sie eine Prävalenz von bis zu 10%, bei Diabetikern bis zu 30%. Typisch ist das gleichzeitige Auftreten von Plus- (Schmerz, Hyperalgesie) und Minus- Symptomen (Hypästhesie, Hypoalgesie) für thermische und/oder mechanische Reize, wobei unterschiedliche Symptomkonstellationen unabhängig von der Krankheitsätiologie auftreten. Die genaue Analyse der sensorischen Symptome erlaubt Rückschlüsse über die Mechanismen der Schmerzentstehung (z. B. periphere und zentrale Sensibilisierung, Störung endogener Schmerzhemmung), was zusammen mit Kenntnis der pharmakologischen Angriffspunkte der üblicherweise eingesetzten Medikamente (Antikonvulsiva, Antidepressiva, Opioide und topisch applizierte Wirkstoffe) eine gezieltere Pharmakotherapie ermöglicht. Einige Studien konnten einen Zusammenhang zwischen sensorischen Profil und Therapieeffekt verschiedener Medikamente nachweisen. Weitere Studien sind notwendig, um diesbezüglich leitlinienrelevante Empfehlungen für die individuelle Therapieauswahl auszusprechen.

Summary

Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. It has a prevalence of up to 10% in the general population, and up to 30% in patients with diabetes mellitus. The concomitant development of positive (pain, hyperalgesia, allodynia) and negative (hypoesthesia, hypoalgesia) sensory signs occurs both for thermal and mechanical stimuli and is typical for neuropathic pain. The exact analysis of the somatosensory profile gives information about the underlying pathomechanisms of pain generation (e. g. peripheral and central sensitization, disturbed endogenous analgesia). Conjoined with the knowledge about the pharmacological actions of the commonly used drugs (e. g. anticonvulsants, antidepressants, opioids and topically applied drugs) a more targeted pharmacotherapy is possible. Several studies have already demonstrated a relationship between the somatosensory profile and the treatment effect for different substances, thus underlining the clinical relevance of the concept of mechanism-based treatment. Further studies are needed in order to include recommendations for individual drug choices into the treatment guidelines.

Schlüsselwörter

Neuropathische Schmerzen - Pharmakotherapie - Pathomechanismen

Keywords

Neuropathic pain - pharmacological treatment - pathomechanisms
 

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