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Diabetes aktuell 2018; 16(03): 102-111
DOI: 10.1055/a-0635-2844
Schwerpunkt
Neurologie
© Georg Thieme Verlag Stuttgart · New York

Mechanismenbasierte Therapie neuropathischer Schmerzen

Wie das sensorische Profil eine gezieltere Therapie ermöglicht
Mainka Tina
1   Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin
,
C. Maier
1   Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin
,
Elena K. Enax-Krumnova
1   Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin
› Author Affiliations
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Publication History

Publication Date:
26 June 2018 (online)

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ZUSAMMENFASSUNG

Neuropathische Schmerzen entstehen als direkte Folge einer Erkrankung oder Läsion des somatosensorischen Systems. In der Allgemeinbevölkerung haben sie eine Prävalenz von bis zu 10 %, bei Diabetikern bis zu 30 %. Typisch ist das gleichzeitige Auftreten von Plus- (Schmerz, Hyperalgesie) und Minussymptomen (Hypästhesie, Hypoalgesie) für thermische und/oder mechanische Reize, wobei unterschiedliche Symptomkonstellationen unabhängig von der Krankheitsätiologie auftreten. Die genaue Analyse der sensorischen Symptome erlaubt Rückschlüsse über die Mechanismen der Schmerzentstehung (z. B. periphere und zentrale Sensibilisierung, Störung endogener Schmerzhemmung), was zusammen mit der Kenntnis der pharmakologischen Angriffspunkte der üblicherweise eingesetzten Medikamente (Antikonvulsiva, Antidepressiva, Opioide und topisch applizierte Wirkstoffe) eine gezieltere Pharmakotherapie ermöglicht. Einige Studien konnten einen Zusammenhang zwischen dem sensorischen Profil und dem Therapieeffekt verschiedener Medikamente nachweisen. Weitere Studien sind notwendig, um diesbezüglich leitlinienrelevante Empfehlungen für die individuelle Therapieauswahl auszusprechen.

 

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