Screening und Diagnostik neuropathischer Schmerzen

Zusammenfassung

Das diagnostische „Work-up“ neuropathischer Schmerzen umfasst Schmerzfragebögen als Screening-Instrumente sowie eine Schmerzzeichnung, Informationen zur Krankheitsgeschichte und eine klinisch-neurologische Untersuchung zur Klärung der Fragen: Ist das Screening zur Ausprägung von Schmerzdeskriptoren vereinbar mit dem Vorliegen eines neuropathischen Schmerzes? Ist das Muster der Schmerzausbreitung und des sensiblen Defizits neuroanatomisch nachvollziehbar? Finden sich Hinweise auf eine relevante Läsion oder Erkrankung der peripheren oder zentralen Anteile des somatosensorischen Systems? Als Ergänzung zur elektrophysiologischen Untersuchung des somatosensorischen Systems hat sich als komplementäres Verfahren die quantitative sensorische Testung etabliert, die anders als konventionelle Verfahren neben sensiblen Defiziten die Erfassung sensibler Pluszeichen erlaubt. Klinische Pluszei-chen wie Hyperalgesie, Hyperpathie und Allodynie oder Minuszeichen wie Hypästhesie und Hypoalgesie können dabei auf dem Schmerz zugrunde liegende neurobiologische Mechanismen hinweisen, wie eine periphere, zentrale Sensibilisierung oder Deafferenzie-rung im nozizeptiven System.

Summary

The diagnostic work-up of neuropathic pain includes screening tools such as pain questionnaires and pain drawings as well as additional information of patients´ disease history and a clinical neurological examination to answer the questions: Is the screening for pain descriptors consistent with the existence of neuropathic pain? Is the pattern of pain distribution and sensory deficit neuroanatomically plausible? Is there a relevant lesion or disease affecting the peripheral or central parts of the somatosensory system? Quantitative sensory testing was established as extension of electrophysiological examination in the somatosensory system to allow testing for both gain and loss of sensory function in contrast to the conventional assessment of exclusively sensory loss. Sensory plus signs (hyperalgesia, hyperpathia and allodynia), or sensory minus signs (hypoesthesia and hypoalgesia) may point to possible underlying neurobiological pain mechanisms such as peripheral and central sensitization, or deafferentation in the nociceptive system.

Schlüsselwörter

Neuropathischer Schmerz - Schmerzfragebogen - painDETECT - LANSS - DN4 - NPQ - QST - quantitative sensorische Testung

Keywords

Neuropathic pain - pain questionnaire - painDETECT - LANSS - DN4 - NPQ - QST - quantitative sensory testing

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