Zeitschrift für Komplementärmedizin 2020; 12(03): 32-37
DOI: 10.1055/a-1173-4194
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Der sensibilisierte Patient in der Schmerztherapie

Petra Bäumler
Further Information

Publication History

Publication Date:
26 June 2020 (online)


Eine Gruppe von Patienten mit chronischen schmerzhaften Erkrankungen zeigen besonders viele unterschiedliche Symptome und ausgeprägte sensorische Sensibilisierungzeichen. Dieses Phänomen wird auch als Hypersensitivitätssyndrom beschrieben.

Aus neurophysiologischer lässt sich dies durch komplexe Sensibilisierungsmechanismen auf Ebene des Rückenmarks und des Gehrins erklären. Gleichsam entscheidend ist die seelische Sensibilisierung – psychische Erkrankungen und negative Affekte, wie eine katastrophisierende Haltung, Ängste und eine depressive Stimmungslage.

Intensive Forschungsarbeit hat gezeigt, dass neurophysiologische und psychologische Faktoren eng verwoben und nicht nur Folgen sondern auch Risikofaktoren für chronische schmerzhafte Erkrankungen sind.

In der Therapie sensibilisierter Patienten haben sich Verfahren bewährt, die den zugrunde liegenden neurophysiologischen Veränderungen entgegenwirken und sich gleichzeitig regulierend auf dysfunktionale Kognitionen, Emotionen und Verhaltensmuster auswirken. Dabei kommt der Komplementärmedizin eine große Bedeutung zu.

  • Literatur

  • 1 Afari N, humada SM, Wright LJ. et al Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosom Med 2014; 76 (01) 2-11
  • 2 Aggarwal VR, McBeth J, Zakrzewska JM. et al The epidemiology of chronic syndromes that are frequently unexplained: Do they have common associated factors?. Int J Epidemiol 2006; 35 (02) 468-476
  • 3 Aoyagi K, He J, Nicol AL. A Subgroup of Chronic Low Back Pain Patients With Central Sensitization. Clin J Pain 2019; 35 (11) 869-879
  • 4 Aron EN, Aron A, Davies KM. Adult shyness: The interaction of temperamental sensitivity and an adverse childhood environment. Pers Soc Psychol Bull 2005; 31 (02) 181-197
  • 5 Baeumler PI, Conzen P, Irnich D. High Temporal Summation of Pain Predicts Immediate Analgesic Effect of Acupuncture in Chronic Pain Patients-A Prospective Cohort Study. Front Neurosci 2019; 13: 498
  • 6 Creed F. Review article: The incidence and risk factors for irritable bowel syndrome in population-based studies. Aliment Pharmacol Ther 2019; 50 (05) 507-516
  • 7 Edwards RR, Dworkin RH, Sullivan M. et al The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. J Pain 2016; 17 (Suppl. 09) T70-92
  • 8 Egorova N, Gollub RL, Kong J. Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain. Neuroimage Clin 2015; 9: 430-435
  • 9 Eller-Smith OC, Nicol AL, Christianson JA. Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions. Front Cell Neurosci 2018; 12: 35
  • 10 Fillingim RB, Ohrbach R, Greenspan JD. et al Psychological factors associated with development of TMD: The OPPERA prospective cohort study. J Pain 2013; 14 (Suppl. 12) T75-90
  • 11 Fox KC, Nijeboer S, Dixon M. et al Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci Biobehav Rev 2014; 43: 48-73
  • 12 Gerhardt A, Eich W, Treede RD. Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia. Pain 2017; 158 (03) 430-439
  • 13 Greenspan JD, Slade GD, Bair E. et al Pain sensitivity risk factors for chronic TMD: Descriptive data and empirically identified domains from the OPPERA case control study. J Pain 2011; 12 (Suppl. 11) T61-74
  • 14 Harris RE, Zubieta JK, Scott DJ. et al Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 2009; 47 (03) 1077-1085
  • 15 Holley AL, Wilson AC, Palermo TM. Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: A prospective study. Pain 2017; 158 (05) 794-801
  • 16 Horn-Hofmann C, Scheel J, Dimova V. et al Prediction of persistent post-operative pain: Pain-specific psychological variables compared with acute post-operative pain and general psychological variables. Eur J Pain 2018; 22 (01) 191-202
  • 17 Irnich D, Bäumler P, Hanley K. Stand der Komplementärmedizin in Deutschland. Zeitschrift für Komplementärmedizin 2019; 11 (06) 14-25
  • 18 Irnich D. Was ist das Hypersensitivitätssyndrom?. Zeitschrift für Komplementärmedizin 2015; 6 (05) 1
  • 19 Jones GT, Power C, Macfarlane GJ. Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British Birth Cohort Study. Pain 2009; 143 1-2 92-96
  • 20 Kato K, Sullivan PF, Pedersen NL. Latent class analysis of functional somatic symptoms in a population-based sample of twins. J Psychosom Res 2010; 68 (05) 447-453
  • 21 Kerr CE, Shaw JR, Wasserman RH. et al Tactile acuity in experienced Tai Chi practitioners: Evidence for use dependent plasticity as an effect of sensory-attentional training. Exp Brain Res 2008; 188 (02) 317-322
  • 22 Khan RS, Ahmed K, Blakeway E. et al Catastrophizing: A predictive factor for postoperative pain. Am J Surg 2011; 201 (01) 122-131
  • 23 Kramer S, Baeumler P, Geber C. et al Somatosensory profiles in acute herpes zoster and predictors of postherpetic neuralgia. Pain 2019; 160 (04) 882-894
  • 24 Kuner R. Central mechanisms of pathological pain. Nat Med 2010; 16 (11) 1258-1266
  • 25 Latremoliere A, Woolf CJ. Central sensitization: A generator of pain hypersensitivity by central neural plasticity. J Pain 2009; 10 (09) 895-926
  • 26 Lin L, Skakavac N, Lin X. et al Acupuncture-Induced Analgesia: The Role of Microglial Inhibition. Cell Transplant 2016; 25 (04) 621-628
  • 27 Lionetti F, Aron A, Aron EN. et al Dandelions, tulips and orchids: Evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals. Transl Psychiatry 2018; 8 (01) 24
  • 28 Liss M, Timmel L, Baxley K. et al Sensory processing sensitivity and its relation to parental bonding, anxiety, and depression. Personality and Individual Differences 2005; 39 (08) 1429-1439
  • 29 Maeda Y, Kim H, Kettner N. et al Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain 2017; 140 (04) 914-927
  • 30 Malfliet A, Coppieters I, Van Wilgen P. et al Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review. Eur J Pain 2017; 21 (05) 769-786
  • 31 Martinez-Calderon J, Zamora-Campos C, Navarro-Ledesma S. The Role of Self-Efficacy on the Prognosis of Chronic Musculoskeletal Pain: A Systematic Review. J Pain 2018; 19 (01) 10-34
  • 32 Mills SEE, Nicolson KP, Smith BH. Chronic pain: A review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019; 123 (02) e273-e283
  • 33 Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: A review. Neurorehabil Neural Repair 2012; 26 (06) 646-652
  • 34 Nahman-Averbuch H, Nir RR, Sprecher E. et al Psychological Factors and Conditioned Pain Modulation: A Meta-Analysis. Clin J Pain 2016; 32 (06) 541-554
  • 35 Nicholson RA, Houle TT, Rhudy JL. et al Psychological risk factors in headache. Headache 2007; 47 (03) 413-426
  • 36 O’Brien AT, Deitos A, Triñanes Pego Y. et al Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms. J Pain 2018; 19 (08) 819-836
  • 37 Pincus T, Burton AK, Vogel S. et al A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976) 2002; 27 (05) E109-120
  • 38 Rabey M, Slater H, OʼSullivan P. et al Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: A cluster analysis. Pain 2015; 156 (10) 1874-1884
  • 39 Rice DA, Kluger MT, McNair PJ. et al Persistent postoperative pain after total knee arthroplasty: A prospective cohort study of potential risk factors. Br J Anaesth 2018; 121 (04) 804-812
  • 40 Schaible HG, Ebersberger A, Natura G. Update on peripheral mechanisms of pain: Beyond prostaglandins and cytokines. Arthritis Res Ther 2011; 13 (02) 210
  • 41 Staud R. Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions. Expert Rev Neurother 2012; 12 (05) 577-585
  • 42 Treede RD. The role of quantitative sensory testing in the prediction of chronic pain. Pain 2019; 160 (Suppl. 01) 66-69
  • 43 Tu Y, Ortiz A, Gollub RL. et al Multivariate resting-state functional connectivity predicts responses to real and sham acupuncture treatment in chronic low back pain. Neuroimage Clin 2019; 23: 101885
  • 44 Vaegter HB, Graven-Nielsen T. Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity. Pain 2016; 157 (07) 1480-1488
  • 45 Velly AM, Mohit S. Epidemiology of pain and relation to psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87 Pt B 159-167
  • 46 Villemure C, Čeko M, Cotton VA. et al Neuroprotective effects of yoga practice: Age-, experience-, and frequency-dependent plasticity. Front Hum Neurosci 2015; 9: 281
  • 47 Wang L, Chang Y, Kennedy SA. et al Perioperative psychotherapy for persistent post-surgical pain and physical impairment: A meta-analysis of randomised trials. Br J Anaesth 2018; 120 (06) 1304-1314
  • 48 Waxman SG, Zamponi GW. Regulating excitability of peripheral afferents: Emerging ion channel targets. Nat Neurosci 2014; 17 (02) 153-163
  • 49 Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000; 288 5472 1765-1769
  • 50 Yunus MB. Fibromyalgia and overlapping disorders: The unifying concept of central sensitivity syndromes. Semin Arthritis Rheum 2007; 36 (06) 339-356
  • 51 Zamani M, Alizadeh-Tabari S, Zamani M. Systematic review with meta-analysis: The prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50 (02) 132-143
  • 52 Zeidan F, Vago DR. Mindfulness meditation-based pain relief: A mechanistic account. Ann N Y Acad Sci 2016; 1373 (01) 114-127