Schmerzhafte diabetische Polyneuropathie

Zusammenfassung

Etwa jeder dritte Diabetiker ist von der distal-symmetrischen Polyneuropathie (DPN) betroffen, die unter Ausbildung von einerseits teils quälenden neuropathischen Schmerzen und andererseits schmerzlosen Fußulzera mit erheblicher Einschränkung der Lebensqualität einhergeht. Die Prävalenz der schmerzhaften DPN liegt bei 13 bis 26%. Die Diagnose der DPN sollte anhand standardisierter Scores für neuropathische Symptome und Defizite objektiviert und im Verlauf kontrolliert werden. Die Therapie der diabetischen Neuropathie umfasst vier Ansätze: kausale Therapie mit dem Ziel einer Nahe-Normoglykämie, pathogenetisch begründbare Therapie, symptomatische Therapie neuropathischer Schmerzen und Vermeidung von Risikofaktoren und Komplikationen. Schmerztherapeutisch stehen insbesondere Antidepressiva wie Duloxetin und Amitriptylin, Kalziumkanal-α2δ-Modulatoren wie Pregabalin und Opioide als Mittel der zweiten Wahl bzw. zur Kombinationstherapie zur Verfügung. Nicht pharmakologische Therapien sind mit zu berücksichtigen. Eine sorgfältige Nutzen-Risiko-Abwägung steht am Anfang einer adäquaten Therapie mit dem Ziel, die Lebensqualität der Betroffenen dauerhaft zu erhalten.

Summary

Approximately one in three people with diabetes is affected by diabetic distal symmetric sensorimotor polyneuropathy (DPN), which is responsible for impaired quality of life by presenting with excruciating neuropathic pain and with painless neuropathic ulcers. The prevalence of painful DPN is 13 to 26%. Diagnosis of DPN should be verified using standardized scores for neuropathic symptoms and deficits and and its course should be monitored. Treatment is based on four cornerstones: intensive diabetes therapy and multi-factorial risk intervention; treatment based on pathogenetic mechanisms; symptomatic treatment; and avoidance of risk factors and complications. Pain treatment includes administration of antidepressants such as duloxetine and amitriptyline, calcium channel α2δ modulators such as pregabalin and opioids as drugs of second choice or for combination therapy. Non-pharmacological treatments always require consideration. Each initiation of treatment requires a thorough estimate of the risk-to-benefit relationship aimed at long-term maintenance of the patients‘ quality of life.

Schlüsselwörter

Schmerzhafte diabetische Neuropathie - Pharmakotherapie - nicht pharmakologische Therapie

Keywords

Painful diabetic neuropathy - pharmaco-therapy - non-pharmacological treatment

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