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Aktuelle Neurologie 2013; 40(06): 321-326
DOI: 10.1055/s-0033-1343339
Workshop
© Georg Thieme Verlag KG Stuttgart · New York

Schmerz bei Parkinson-Patienten

Pain in Parkinson’s Disease
I. Csoti
1   Gertrudis Klinik Biskirchen, Parkinson-Zentrum
,
W. Fogel
2   Fachbereich Neurologie, Deutsche Klinik für Diagnostik Wiesbaden
,
S. Schade
3   Klinik für Klinische Neurophysiologie, Georg-August-Universität Göttingen
,
A. Schnitzler
4   Neurologische Klinik der Heinrich-Heine Universität – Bewegungsstörungen und Neuromodulation, Düsseldorf, Institut für klinische Neurowissenschaften und Medizinische Psychologie der Heinrich- Heine-Universität, Medizinische Fakultät, UKD, Düsseldorf
,
M. Südmeyer
4   Neurologische Klinik der Heinrich-Heine Universität – Bewegungsstörungen und Neuromodulation, Düsseldorf, Institut für klinische Neurowissenschaften und Medizinische Psychologie der Heinrich- Heine-Universität, Medizinische Fakultät, UKD, Düsseldorf
,
C. Winkler
5   Neurologische Universitätsklinik Freiburg sowie Krankenhaus Lindenbrunn, Coppenbrügge
,
J. Winkler
6   Molekular-Neurologische Abteilung, Universitätsklinikum Erlangen
› Author Affiliations
Further Information

Publication History

Publication Date:
14 August 2013 (online)

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Zusammenfassung

Schmerzen und Missempfindungen bei Morbus Parkinson (MP) werden zu den nichtmotorischen Krankheitssymptomen gezählt und haben bedeutenden Einfluss auf das Wohlbefinden und damit die gesundheitsbezogene Zufriedenheit und Lebensqualität von Parkinson-Patienten. Obgleich sie sehr häufig auftreten, werden sie bis heute allzu oft nicht angemessen wahrgenommen und therapiert. Die Gründe dafür sind u. a. in der Vielfältigkeit der Schmerzen und in der anspruchsvollen Differenzialdiagnostik zu suchen. Die Krankheit vereint unter dem Überbegriff Morbus Parkinson Schmerzen verschiedenster Art. In Analogie zum chronischen Schmerzsyndrom kann man jedoch 3 große Subgruppen unterscheiden: den neuropathischen, den nozizeptiven und den gemischten Schmerz (mixed pain). Die Pathophysiologie von Schmerzen bei Parkinson ist sehr komplex und in vielen Punkten noch unklar. Neue wissenschaftliche Erkenntnisse weisen auf eine Dysfunktion der Basalganglien bei der Entstehung, Weiterleitung und Verarbeitung von Schmerzen hin.

Schmerzen können bereits in der präsymptomatischen Krankheitsphase auftreten und der motorischen Symptomatik vorausgehen, oder aber sie treten in Analogie zu den motorischen Krankheitssymptomen nach Diagnosestellung auf. Es gibt Schmerzen, die durch eine Optimierung der dopaminergen Medikation gelindert werden können, aber auch Schmerzen, die keine Response auf L-Dopa zeigen.

Schmerzen, welche durch motorische Krankheitssymptome und Off-Phasen assoziiert auftreten, weisen auf eine notwendige Optimierung der dopaminergen Medikation hin. Botulinumtoxin hat sich in der Therapie fokaler Dystonien bewährt. Kasuistisch wird über eine Besserung von Schmerzen und Dysästhesien nach tiefer Hirnstimulation berichtet. Nicht L-Dopa-responsive Schmerzen sollten einer multimodalen Schmerztherapie zugeführt werden, welche insbesondere auf mögliche Interaktionen mit Parkinson-Medikamenten Rücksicht nehmen sollte.

Abstract

Pain and discomfort in Parkinson’s disease (MP) are counted as non-motor symptoms and disease have significant impact on the well-being and health satisfaction and the quality of life of PD patients. Although they occur very often, they are still too often not adequately perceived and treated. The reasons for this are, among other things, the diversity of pain and in the challenging differential diagnosis. The disease together under the umbrella term Parkinson's disease pain of various kinds analogous to chronic pain syndrome can, however, distinguish three major subgroups: the neuropathic, nociceptive and mixed pain. The pathophysiology of pain in Parkinson’s disease is very complex and still unclear in many respects. New scientific findings indicate a dysfunction of the basal ganglia in the development, transfer and processing of pain.

Pain may occur already in the pre-symptomatic phase of the disease and motor symptoms precede, or they occur in analogy to the motor symptoms after diagnosis. There is pain that can be alleviated by optimizing the dopaminergic medication, but also pain, show no response to Levodopa.

Pain, which occur associated with motor symptoms and off phases, indicate a necessary optimization of dopaminergic medication. Botulinum toxin has proven effective in the treatment of focal dystonias. Casuistic reports on improvement of pain and dysesthesia after deep brain stimulation. Not Levodopa responsive pain should be fed a multimodal pain therapy, which should in particular take on possible interactions with Parkinson's medications consideration.

Schlüsselwörter

Schmerz - Morbus Parkinson - dyston - nozizeptiv - neuropathisch

Keywords

pain - Parkinson’s disease - dystonic - nociceptive - neuropathic
 

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