Serotonerge Modulation der Schmerzwahrnehmung

Zusammenfassung

Gegenstand und Ziel: Chronische Schmerzen sind ein häufiges Krankheitssymptom und führen zu erheblichen Einschränkungen der Alltagsfunktionalität. Für erfolgreiche therapeutische Ansätze erscheint ein profundes Verständnis insbesondere der pathophysiologischen Mechanismen im zentralen Nerven-system wertvoll. Neben dem seit langem im Zentrum der Forschung stehenden Opioidsystem rückt zunehmend das monoaminerge System in den Vordergrund. Material und Methoden: Diese Übersichtsarbeit fasst ausgewählte Forschungsergebnisse zur Rolle des serotonergen Systems in der zentralen Schmerzmodulation zusammen. Ergebnisse: Eine Reihe von Tierversuchen zeigt sowohl antinozizeptive wie auch pronozizeptive Wirkungen von Serotonin auf Rückenmarksebene. Untersuchungen an gesunden Probanden zeigen weiterhin Hinweise auf erhöhte Schmerzempfindlichkeit unter verminderter zentraler Serotoninverfügbarkeit bei akutem Schmerz. Untersuchungen an chronischen Schmerzpatienten mit Fibromyalgie zeigen reduzierte Abbauprodukte des Serotoninstoffwechsels im Liquor, erhöhte Antikörper gegen Serotonin und Serotoninrezeptoren sowie inkonsistente Ergebnisse bezüglich genetischer Prädisposition. Im klinischen Einsatz erwiesen sich rein serotonerge Substanzen als we-niger wirksam in der Behandlung chronischer Schmerzen als Pharmaka mit zusätzlich noradrenerger Komponente. Schlussfolgerung: Eine breite Basis an grundlagenwissenschaft-lichen Befunden weist auf einen bedeutsamen Einfluss serotonerger Transmission auf die Schmerzwahrnehmung hin. Klinische Relevanz: Der Einsatz von rein serotonerg wirksamen Pharmaka, wie den Serotoninwiederaufnahmehemmern, kann nur bei Komorbidität chronischer Schmerzen mit Depression empfohlen werden.

 

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Summary

Objective: Chronic pain is a common disease condition and results in a loss of function in daily life. For the development of effective treatments, a thorough understanding of pathophysiological mechanisms of the central pain modulation seems mandatory. After the opioid system, recent research focused on the monoaminergic system. Material and methods: The article summarizes current research on the role of the serotonergic system in central pain modulation. Results: Animal research reports antinociceptive as well as pronociceptive effects of serotonin on spinal cord levels. Studies on acute experimental pain in healthy human sujects suggest increased sensitivity to pain along with reduced central avaliability of serotonin. In patients with the chronic pain syndrome fibromyalgia, reduced metabolites of sertonin were found in the cerebrospinal fluid, together with increased serotonin receptor antibodies and inconsistent results regarding genetic susceptibility. In therapeutic settings, purely serotonergic substances were clearly less effective compared to those with an additional noradrenergic effect. Conclusion: Previous basic research shows that serotonergic transmission has a great impact on pain perception. The interpretation of the experimental pain studies in which acute pain conditions are usually applied allow only limited transfer to clinical practise for treatment of chronic pain diseases. Clinical relevance: Currently, the use of solely serotonergic substances in the treatment of chronic pain disorders can be recommended only in the case of comorbid depression.

 

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Schlüsselwörter:

Serotonin - Schmerzwahrnehmung - deszendierende Schmerzmodulation

Keywords

Serotonin - pain perception - descending pain modulation

 

 

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Interessenkonflikt

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