Schmerzen und Missempfindungen bei Parkinson-Patienten

A. Ceballos-Baumann

doi:10.1055/s-0038-1627571

Nervenheilkunde, Table of Contents

Nervenheilkunde 2015; 34(03): 167-173
DOI: 10.1055/s-0038-1627571

Parkinson

Schattauer GmbH

Schmerzen und Missempfindungen bei Parkinson-Patienten

Pain and sensory complaints in patients with Parkinson’s disease

Authors

A. Ceballos-Baumann

¹Abt. für Neurologie und klinische Neurophysiologie mit Parkinson-Fachklinik, Schön Klinik München Schwabing

Abstract

Zusammenfassung

Parkinson-Patienten klagen sehr häufig über Schmerzen und Missempfindungen. Das therapeutische Vorgehen zielt zunächst auf eine Optimierung der dopaminergen Medikation, da Schmerzen häufig mit der Akinese und dem Rigor zusammenhängen und mit motorischen Fluktuationen korrelieren. Dabei kommt auch den Eskalationstherapien wie der subkutanen Apomorphin-, der jejunalen Levodopa-Carbidopa-Infusion und der tiefen Hirnstimulation eine Rolle zu. Botulinumtoxin ist hilfreich bei mit Off-Dystonien assoziierten Schmerzen. Der Einsatz von Analgetika einschließlich von Opioiden ist notwendig bei parkinsonunabhängigen Schmerzen oder bei durch Dopaminergika nicht modifizierbare Schmerzen. Opioide können Rigor verstärken und die Entwicklung von Delirien begünstigen.

Summary

Pain and sensory complaints are common among patients with Parkinson’s disease. Despite its high prevalence in Parkinson’s disease the burden of pain is often underestimated, misdiagnosed and not correctly treated. Therapeutic strategies should firstly aim at sufficient dopaminergic stimulation since pain is frequently linked to akinesia, rigidity and may fluctuate similarly to motor signs. In this setting subcutaneous apomorphine or jejunal levodopa/carbidopa infusion and deep brain stimulation will play a role. Botulinum toxin may be helpful in painful dystonic spasms. Analgesics are necessary in Parkinson independent pain or pain which is not modifiable with dopaminergic drugs. Opioids can exacerbate rigidity and produce confusional states.

Schlüsselwörter

Schmerz - chronisches Schmerzsyndrom - Parkinson-Syndrom - Levodopa - Dopaminergika - Restless-legs-Syndrom

Keywords

Pain - Parkinson’s disease - parkinsonism - rest legs syndrom - levodopa

Full Text

References

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