Skip to main content
SpringerLink
Log in

Neuropathische Schmerzen

Pathophysiologie, Diagnostik und Therapie

  • Chapter
Weiterbildung Schmerzmedizin

  • 2801 Accesses

Zusammenfassung

Neuropathische Schmerzen sind bedingt durch Läsionen im somatosensorischen System. Charakteristische, aber nicht exklusive Merkmale sind spontane Brennschmerzen, elektrisierende und einschießende Schmerzen, Hyperalgesie und Allodynie. Das Grundkonzept der Pathophysiologie neuropathischer Schmerzen besteht in der Kombination aus peripherer und zentraler Sensibilisierung. Die Kenntnisse über molekulare Mechanismen sind in den vergangenen Jahren exponentiell angewachsen. Problematisch sind die Gewichtung der einzelnen Mechanismen sowie die Erstellung eines integrierten Gesamtkonzepts. Fortschritte gab es auch in der Diagnostik, z. B. wurden die Methoden zur Erfassung von Funktionsstörungen der Nozizeptoren deutlich verbessert. Für die Therapie stehen heute weit mehr Optionen zur Verfügung als noch vor 15 Jahren. Unter den verfügbaren Medikamenten sind Antidepressiva, Antikonvulsiva, Opiate und Lokaltherapeutika. Daten aus kontrollierten Studien und Empfehlungen aus Leitlinien liegen vor.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 29.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 17.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Treede RD, Jensen TS, Campbell JN et al (2008) Neuropathie pain: redefinition and agrading system for c1inical and research purposes. Neurology 70:1630–1635

    Google Scholar 

  2. Ochoa JL, Campero M, Serra J, Bostock H (2005) Hyperexcitable polymodal and insensitive nociceptors in painful human neuropathy. Muscle Nerve 32:459–472

    Article  PubMed  Google Scholar 

  3. Serra J, Bostock H, Sola Ret al (2012) Microneurographic identification of spontaneous activity in C-nociceptors in neuropathie pain states in humans and rats. Pain 153:42–55

    PubMed  Google Scholar 

  4. Goldin AL, Barchi RL, Caldwell JH et al (2000) Nomenclature ofvoltage- gated sodium channels. Neuron 28:365–368

    Article  PubMed  Google Scholar 

  5. Dib-Hajj SD, Yang Y, Black JA, Waxman SG (2013) The Na(V)1.7 sodium channel:from moleculeto man. Nat Rev Neurosei 14:49–62

    Google Scholar 

  6. Jin X, Gereau RWT (2006) Acute p38mediated modulation oftetrodotoxin-resistant sodium channels in mouse sensory neurons bytumor necrosis factor-alpha. J Neurosei 26:246–255

    Google Scholar 

  7. Üçeyler N, Sommer C (2008) Cytokine regulation in animal models of neuropathie pain and in human diseases. Neurosei Lett 437:194–198

    Google Scholar 

  8. Üçeyler N, Rogausch Jp, Toyka KV, Sommer C (2007) Differential expression of cytokines in painful and painless neuropathies. Neurology 69:424–9

    Article  Google Scholar 

  9. Üçeyler N, Kafke W, Riediger Net al (2010) Elevated proinflammatory cytokine expression in affected skin in small fiber neuropathy. Neurology 74:1806–1813

    Google Scholar 

  10. Katz N, Borenstein DG, Birbara Cet al (2011) Efficacy and safety oftanezumab in the treatment of chronic low back pain. Pain 152:2248–2258

    Article  PubMed  Google Scholar 

  11. Palazzo E, Luongo L, Novellis Vde et al (2012) Transient receptor potential vanilloid type 1and pain development. Curr üpin PharmacoI12:91–7

    Google Scholar 

  12. Bierhaus A, Fleming T, Stoyanov 5 et al (2012) Methylglyoxal modification of Nav1.8 facilitates nociceptive neuron firing and causes hyperalgesia in diabetic neuropathy. Nat Med 18:926–933

    Google Scholar 

  13. Dubovy P (2011) Wallerian degeneration and peripheral nerve conditions for both axonal regeneration and neuropathie pain induction. Ann Anat 193:267–275

    Article  PubMed  Google Scholar 

  14. Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:52–515

    Article  Google Scholar 

  15. Scholz J, Woolf CJ (2007) The neu ropathic pain triad: neurons, immune cells and glia. Nat Neurosci 10:1361136–8

    Google Scholar 

  16. Kawasaki Y, Zhang L, Cheng JK, Ji RR (2008) Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1 beta, interleukin-6, and tumor necrosis factor- alpha in regulating synaptic and neuronal activity in the superficial spinal cord. JNeurosei 28:5189–5194

    Google Scholar 

  17. Coull JA, Beggs 5, Boudreau Det al (2005) BDNF from microglia causes the shift in neuronal anion gradient underlying neuropathie pain. Nature 438:1017–1021

    Google Scholar 

  18. Knabl J, Witschi R, Hosl Ket al (2008) Reversal of pathological pain through specific spinal GABAA receptor subtypes. Nature 451 :33033–4

    Article  Google Scholar 

  19. Haanpää M, Attal N, Backonja M et al (2011) NeuPSIG guidelines on neuropathie pain assessment. Pain 152:14–27

    PubMed  Google Scholar 

  20. Galer BS, Jensen MP (1997) Development and preliminary validation of a pain measure specific to neuropathie pain: the Neuropathie Pain Scale. Neurology 48:332–338

    Article  PubMed  Google Scholar 

  21. Bouhassira D, Attal N, Fermanian J et al (2004) Development and validation ofthe Neuropathie Pain Symptom lnventory. Pain 108:248–257

    Article  PubMed  Google Scholar 

  22. Sommer C, Richter H, Rogausch JP et al (2011) A modified score to identify and discriminate neuropathie pain: a study on the German version of the neuropathie pain symptom inventory (N PSI). BMC Neuro111:10–4

    Google Scholar 

  23. Baron R, Binder A, Birklein Fet al (2012) Diagnostik neu ropathischer Schmerzen. In: Diener H-C, Weimar C (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie, 5. Auf!. Thieme, Stuttgart

    Google Scholar 

  24. Treede RD, Lorenz J, Baumgartner U (2003) Clinical usefulness of laserevoked potentials. Neurophysiol Clin 33:303–314

    Article  PubMed  Google Scholar 

  25. Chen AC, Niddam DM, Arendt-Nielsen L (2001) Contact heat evoked potentials as a valid means to study nociceptive pathways in human subjects. Neurosci Lett 316:79–82

    Article  PubMed  Google Scholar 

  26. Hansen N, übermann M, Üçeyler Net al (2012) Klinische Anwendung schmerzevozierter Potenziale. Schmerz 26:8–15

    Article  PubMed  Google Scholar 

  27. Rolke R, Baron R, Maier Cet al (2006) Quantitative sensory testing in the German Research Network on Neuropathie Pain (DFNS): standardized protocol and reference values. Pain 123:231–243

    Article  PubMed  Google Scholar 

  28. Maier C, Baron R, Tolle TR et al (2010) Quantitative sensory testing in the German Research Network on Neuropathie Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathie pain syndromes. Pain 150:439–450

    Article  PubMed  Google Scholar 

  29. Sommer C, Lauria G (2007) Skin biopsy in the management of peripheral neuropathy. Laneet NeuroI6:63264–2

    Google Scholar 

  30. Üçeyler N, Zeller D, Kahn AK et al (2013) Small fibre pathology in patients with fibromyalgia syndrome. Brain 136(Pt 6):1857–1867

    Article  PubMed  Google Scholar 

  31. Biekel A, Heyer G, Senger Cet al (2009) C-fiber axon reflex flare size eorrelates with epidermal nerve fiber density in human skin biopsies. J Peripher Nerv Syst 14:294–299

    Google Scholar 

  32. Nnoaham KE, Kumbang J (2008) Transeutaneous eleetrieal nerve stimulation (TENS) for ehronie pain. Coehrane Database Syst Rev:CD003222

    Google Scholar 

  33. Ezzo J, Berman B, Hadhazy VA et al (2000) Is aeu pu netu re effeetive for the treatment of ehronie pain? Asystematie review. Pain 86:217–225

    Article  PubMed  Google Scholar 

  34. Baron R, Binder A, Birklein Fet al (2012) Pharmakologische nieht-interventionelle Therapie chronisch neuropathischer Schmerzen. In: Diener HC, Weimar C(Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie, 5. Aufl. Thieme, Stuttgart

    Google Scholar 

  35. Attal N, Crueeu B, Baron Ret al (2009) EFNS guidelines on the pharmaeologieal treatment of neuropathie pain: 2009 revision. Eur J NeuroI17:1010101–8

    Google Scholar 

  36. Dworkin RH, O'Connor AB, Audette Jet al (2010) Recommendations for the pharmaeologieal management of neuropathie pain: an overview and literature update. Mayo Clin Proe 85:53–514

    Google Scholar 

  37. National Institute for Health and Clinieal Exeellenee. http://www.niee.org.uklguidanee/CG96

  38. Attal N, Crueeu G, Baron Ret al (2010) EFNS guidelines on the pharmaeologieal treatment of neuropathie pain: 2010 revision. Eur JNeurol 17:1113–e88

    Google Scholar 

  39. Zakrzewska JM, MeMilian R (2011) Trigeminal neuralgia: the diagnosis and management of this excruciating and poorly understood facial pain. Postgrad Med J87:410–416

    Article  Google Scholar 

  40. Finnerup NB, Sindrup SH, Jensen TS (2010) The evidenee for pharmaeologieal treatment of neuropathie pain. Pain 150:573–581

    Article  PubMed  Google Scholar 

  41. Hoitsma E, Marziniak M, Faber CG et al (2002) Small fibre neuropathy in sarcoidosis. Laneet 359:2085–2086

    Google Scholar 

  42. Eisenberg E, MeNicol E, Carr DB (2006) Opioids for neuropathie pain. Coehrane Database Syst Rev 3:CD00614–6

    Google Scholar 

  43. Khaliq W, Alam 5, Puri N (2007) Topieallidoeaine for the treatment of postherpetie neuralgia. Coehrane Database Syst Rev:CD004846

    Google Scholar 

  44. Gilron I, Bailey JM, Tu Det al (2009) Nortriptyline and gabapentin, alone and in eombination for neuropathie pain: adouble-blind, randomised eontrolled crossover trial. Laneet 374:1252–1261

    Google Scholar 

  45. Gilron I, Bailey JM, Tu Det al (2005) Morphine, gabapentin, or their eombination for neuropathie pain. NEngl JMed 352:1324–1334

    Google Scholar 

  46. Gatti A, Sabato AF, Oeehioni Ret al (2009) Controlled-release oxyeodone and pregabalin in the treatment of neuropathie pain: results of a multieenter Italian study. Eur Neurol 61:129–137

    Article  PubMed  Google Scholar 

  47. Wiffen PJ (2012) Combination pharmaeotherapy for the treatment of neuropathie pain in adults. J Pain Palliat Care Pharmaeother 26:38–0

    Google Scholar 

  48. Crueeu G, AzizTZ, Garcia-Larrea L et al (2007) EFNS guidelines on neurostimulation therapyfor neuropathie pain. Eur JNeuroI14:952–970

    Google Scholar 

  49. Nizard J, Raoul 5, Nguyen Jp, Lefaueheur JP (2012) Invasive stimulation therapies for the treatment of refraetory pain. Diseov Med 14:237–246

    Google Scholar 

  50. Zakrzewska JM, Coakham HB (2012) Mierovaseular decompression for trigeminal neuralgia: update. Curr Opin NeuroI25:296–301

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurologische Klinik, Universitätsklinikum Würzburg, Würzburg

    C. Sommer

Authors
  1. C. Sommer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Sommer, C. (2015). Neuropathische Schmerzen. In: Weiterbildung Schmerzmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46517-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-46517-2_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46516-5

  • Online ISBN: 978-3-662-46517-2

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation