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Schmerztherapie bei chronischer Pankreatitis und chronisch-entzündlichen Darmerkrankungen

Pain management in chronic pancreatitis and chronic inflammatory bowel diseases

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Zusammenfassung

Neben der gestörten Sekretion und lokalen Entzündung sind bei der chronischen Pankreatitis zentrale Mechanismen für die Schmerzentstehung relevant. Daher können in der medikamentösen Therapie neben klassischen Schmerzmitteln zentral wirksame Koanalgetika eingesetzt werden. Endoskopische Interventionen am Gangsystem bieten sich bei offensichtlichen Abflussstörungen an. Chirurgische Interventionen sind insgesamt effektiver, werden aber meist bei medikamentösem oder endoskopischem Therapieversagen eingesetzt, wobei in unterschiedlichen Situationen verschiedene Operationsmethoden mit unterschiedlicher Effektivität, aber auch Morbidität eingesetzt werden.

Hauptproblem bei chronisch-entzündlichen Darmerkrankungen sind meist abdominale Schmerzen. Die Therapie der Grunderkrankung steht hier im Vordergrund. Neben Paracetamol und Tramadol können auch hier gelegentlich Prinzipien einer multimodalen Schmerztherapie zum Einsatz kommen. Bei Gelenkschmerzen und enteropathieassoziierten Arthritiden bieten sich Therapien der chronisch-entzündlichen Darmerkrankung mit Medikamenten an, die auch bei anderen Spondylarthritiden zum Einsatz kommen.

Abstract

Apart from local inflammation and defects in secretion, central mechanisms are important for pain etiology in chronic pancreatitis. Therefore, centrally acting co-analgetic agents can be used in addition to classical pain medications. Endoscopic interventions are preferred in patients with obvious dilation of the pancreatic duct. Surgical interventions are generally more effective although they are usually reserved for patients with prior failure of conservative treatment. Diverse surgical options with different efficacies and morbidities are used in individual patients.

One of the main problems in chronic inflammatory bowel diseases is abdominal pain. Primarily the underlying disease needs to be adequately treated. Symptomatic pain management will most likely include treatment with acetaminophen and tramadol as well as occasionally principles of a multimodal pain regimen. For the treatment of arthralgia as well as enteropathy-associated arthritis the same treatment options are available as for other spondyloarthritic disorders.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J.C. Preiß war als Referent für die Firmen AbbVie und Pfizer sowie die Falk Foundation tätig, erhielt ein Beraterhonorar von der Firma MSD und Reisekostenübernahme von der Firma Ferring. J.C. Hoffmann war als Referent für die Falk Foundation, AbbVie und MSD tätig. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    J.C. Preiß

  2. Medizinische Klinik I, St. Marienkrankenhaus, Ludwigshafen, Deutschland

    J.C. Hoffmann

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Correspondence to J.C. Preiß.

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Preiß, J., Hoffmann, J. Schmerztherapie bei chronischer Pankreatitis und chronisch-entzündlichen Darmerkrankungen. Schmerz 28, 294–299 (2014). https://doi.org/10.1007/s00482-014-1407-5

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