Neuropathische Schmerzen – Ursachen und Therapieansätze

Zusammenfassung

Neuropathische Schmerzen sind chronische Schmerzen welche durch eine Schädigung oder Erkrankung somatosensorischer Strukturen im peripheren und zentralen Nervensystem entstehen. Sie sind gekennzeichnet durch teilweise brennende Spontanschmerzen, einschießende Schmerzattacken und evozierte Schmerzen (Allodynie, Hyperalgesie). Pathophysiologisch liegt neuropathischen Schmerzen eine veränderte Signalverarbeitung sowohl im peripheren als auch zentralen Nervensystem zugrunde. Nervenläsionen oder ein permanenter nozizeptiver Input führen zu molekularen Veränderungen auf Ebene des nozizeptiven Neurons, welche im Rahmen einer peripheren Sensibilisierung zu einer Spontanaktivität dieser Faserafferenzen führt. Die Überaktivität der primären schmerzleitenden Afferenz induziert sekundäre Veränderungen auch auf Rückenmarksebene und supraspinal (zentrale Sensibilisierung). Die medikamentöse Therapie umfasst derzeit verschiedene orale Substanzklassen (Antidepressiva, Antikonvulsiva, Opioide), zudem spielen auch topische Therapeutika wie Capsaicin und Lokalanästhetika eine zunehmend wichtigere Rolle. Bemühungen Patienten mit neuropathischen Schmerzsyndromen hinsichtlich ihres sensorischen Phänotyps genauer zu charakterisieren, sollen in Zukunft eine mechanismenorientierte Therapieplanung ermöglichen.

Abstract

Neuropathic pain is a chronic pain condition which may arise after a lesion or disease of the peripheral or central nervous system. It is clinically characterised by burning spontaneous pain, shooting pain sensations and evoked pain (hyperalgesia, allodynia). Pathophysiological changes in signal processing in the peripheral and central nervous system contribute to the development of neuropathic pain. Nerve lesions or permanent nociceptive input trigger molecular changes in nociceptive neurons leading to spontaneous activity of nerve fibre afferents as a consequence of peripheral sensitisation. Hyperactivity in nociceptors drives secondary changes in the spinal cord and brain (central sensitisation). The medical management of neuropathic pain covers different classes of oral medication (antidepressants, anticonvulsants, opioids). In addition more attention is being paid to topical medications like capsaicin and local anaesthetics. Efforts to characterise the sensory phenotype of neuropathic pain patients and its translation to possible underlying mechanisms may support a mechanism-based therapy in the future.

Schlüsselwörter

neuropathischer Schmerz - periphere und zentrale Sensibilisierung - Therapieprinzipien

Key words

neuropathic pain - peripheral and central sensitization - therapy of neuropathic pain

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