Neurostimulation chronischer Schmerzsyndrome

Zusammenfassung

Circa 20 Prozent aller Patienten in Deutschland, die eine schmerztherapeutische Spezialeinrichtung aufsuchen, leiden unter ungenügend therapierten neuropathischen Schmemrzen. Mittlerweile liegen aussagekräftigen Studien vor, die für die angewendeten Neuromodulationsverfahren einen hohen Evidenzgrad erreichen. Die Epidurale Rückenmarkstimulation (Spinal Cord Stimulation, SCS) ist ein solches neuromodulatorisches, reversibles interventionelles Verfahren für Patienten mit chronischen, mit konservativen und weniger invasiven Mitteln nicht ausreichend therapierbaren Schmerzen. Die Selektion eines Patienten für eine SCS Therapie ist hauptsächlich durch die entsprechende Diagnose begründet. Die SCS kann bei verschiedenen Formen neuropathischer, sympathisch vermittelter oder ischämischer Schmerzen hilfreich sein. Die pathophysiologischen Grundlagen, inklusive der spinalen und supraspinalen Mechanismen der Neurostimulation werden dargestellt. Die verschiedenen Prinzipien der Stimulation, herkömmliche tonische, wie auch neue Stimulationsparameter der Burst und HF Stimulation als auch die Stimulation des Spinalganglions werden erwähnt. Indikationsstellung und auch Patientenselektion sowie neue Aspekte der Stimulationstechniken des peripheren Nervensystems werden in den Kontext der veränderten technischen Möglichkeiten gestellt.

Abstract

In Germany approximately 20 percent of all patients who visit a specialist pain therapy facility suffer from inadequately treated neuropathic diseases. In the meantime, studies have become available with adequate evidence in support of neuromodulation methods. Epidural spinal cord stimulation (SCS) is such a neuromodulatory, reversible interventional procedure for patients with chronic pain that cannot be adequately treated with conservative and less invasive means. The selection of a patient for SCS therapy is based on the appropriate diagnosis. SCS can be helpful in various forms of neuropathic, sympathetically mediated, or ischemic pain. The pathophysiological principles, including the spinal and supraspinal mechanisms of neurostimulation, are presented. The different principles of stimulation, conventional tonic, as well as new stimulation parameters of burst and HF stimulation as well as the stimulation of the spinal ganglion are described. Indication, patient selection as well as new aspects of the stimulation techniques of the peripheral nervous system are placed in the context of the changed technical possibilities.py is mainly based on the corresponding diagnosis. SCS can be helpful in various forms of neuropathic, sympathetically mediated, or ischemic pain. The pathophysiological principles, including the spinal and supraspinal mechanisms of neurostimulation, are presented. The different principles of stimulation, conventional tonic, as well as new stimulation parameters of burst and HF stimulation as well as the stimulation of the spinal ganglion are mentioned. Indication and also patient selection as well as new aspects of the stimulation techniques of the peripheral nervous system are placed in the context of the changed technical possibilities.

Schlüsselwörter

neurostimulation - neuromodulation - Chronischer Schmerz - spinal cord stimulation

Key words

chronic pain - neurostimulation - neuromodulation - spinal cord stimulation

Publikationsverlauf

Artikel online veröffentlicht:
22. Mai 2024

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