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Messung von Muskelschmerz und Hyperalgesie

Experimentelle und klinische Befunde

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Zusammenfassung

Fragestellung

Hyperalgesie und Übertragung spielen bei chronischen muskuloskelettalen Schmerzen eine wichtige Rolle. Um die Behandlungskonzepte verbessern zu können, sind genauere Messmethoden für Muskelschmerz erforderlich.

Methode

Quantitative sensorische Testmethoden wurden eingesetzt, um die Manifestationen von Muskelschmerz in standardisierter Weise auszuwerten.

Ergebnisse

Eine gesteigerte Empfindlichkeit des Muskels äußert sich als 1. Schmerzen, die durch normalerweise nicht schmerzhafte Reize hervorgerufen werden (Allodynie), 2. verstärkte Schmerzen als Reaktion auf Schmerzreize (Hyperalgesie) oder 3. Vergrößerung der Gebiete, in denen übertragene Schmerzen empfunden werden. Diese Phänomene werden teils auf periphere, teils auf zentralnervöse Sensibilisierungsprozesse zurückgeführt.

Schlussfolgerungen

Ein wesentlicher Teil der Schmerzmanifestationen ist offensichtlich durch periphere und zentrale Sensibilisierungen bedingt, die auch bei der Chronifizierung eine Rolle spielen.

Abstract

Aim

It is evident that muscle hyperalgesia and referred pain have an important role in chronic musculoskeletal pain. More knowledge of the basic mechanisms involved and better methods of assessing muscle pain in clinical practice are needed so that treatment regimens can be revised and improved.

Methods

Methods of quantitative sensory testing of muscle pain and associated phenomena are described. These methods make it possible to evaluate manifestations of muscle pain in a standardised way both in patients suffering from musculoskeletal pain and in healthy volunteers.

Results

Elevated muscle sensitivity becomes manifest as (1) pain evoked by a normally non-noxious stimulus (allodynia), (2) abnormally intense pain evoked by noxious stimuli (hyperalgesia), or (3) unusually large areas of referred pain with associated somatosensory changes. These changes can occur as increased somatosensory sensitivity of deep somatic tissues or of the skin in areas of pain referral. Some manifestations of sensitisation in chronic musculoskeletal pain patients, such as expansion of the areas of referred muscle pain, can be explained by the extrasegmental spread of central sensitisation seen in animal experiments.

Conclusions

An important part of the manifestations of pain in chronic musculoskeletal disorders may be due to peripheral and central sensitisation processes, which are also involved in the transition from acute to chronic pain. Knowledge of these processes has expanded enormously in recent years; it should be utilised when new intervention strategies are designed.

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Danksagung

Die Autoren L. Arendt-Nielsen und T. Graven-Nielsen danken der Danish National Research Foundation und dem Danish Research Council für die erhaltene Unterstützung.

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Authors and Affiliations

  1. Laboratory for Human Experimental Pain Research, Center for Sensory-Motor Interaction, Department of Health Sciences and Technology, Universität Aalborg, Dänemark

    L. Arendt-Nielsen & T. Graven-Nielsen

  2. Institut für Anatomie und Zellbiologie III, Universität Heidelberg

    S. Mense

  3. Laboratory for Human Experimental Pain Research, Center for Sensory-Motor Interaction, Department of Health Sciences and Technology, Universität Aalborg , Fredrik Bajers Vej 7, Bld. D3, 9220, Aalborg, Dänemark

    L. Arendt-Nielsen

Authors
  1. L. Arendt-Nielsen
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  2. S. Mense
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  3. T. Graven-Nielsen
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Corresponding author

Correspondence to L. Arendt-Nielsen.

Additional information

Prof. Dr. S. Mense ist für die Übersetzung ins Deutsche verantwortlich.

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Arendt-Nielsen, L., Mense, S. & Graven-Nielsen, T. Messung von Muskelschmerz und Hyperalgesie. Schmerz 17, 445–449 (2003). https://doi.org/10.1007/s00482-003-0260-8

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  • DOI: https://doi.org/10.1007/s00482-003-0260-8

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