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Der Schmerz

, Volume 32, Issue 3, pp 217–230 | Cite as

Das komplexe regionale Schmerzsyndrom (CRPS)

Ein Update
  • V. Dimova
  • F. Birklein
CME
  • 1.2k Downloads

Zusammenfassung

In der Akutphase des komplexen regionalen Schmerzsyndroms (CRPS) dominiert pathophysiologisch eine Aktivierung des Immunsystems und der damit zusammenhängenden Entzündungsreaktion. Im Verlauf entwickeln sich zentralnervös bedingte Symptome wie Hyperalgesie, Sensibilitätsverlust und Körperwahrnehmungsstörungen. Psychologische Faktoren wie schmerzspezifische Ängste und traumatische Ereignisse beeinflussen den Krankheitsverlauf negativ. Die sichtbaren entzündlichen Symptome verbessern sich, aber oft persistiert der Schmerz. Eine zielgerichtete Therapie unterstützt die gute Prognose. Eine wirksame multidisziplinäre Behandlung umfasst eine Pharmakotherapie mit Steroiden, Bisphosphonaten oder Dimethylsulfoxidcreme (Akutphase) und antineuropathischen Schmerzmitteln (alle Phasen), eine Physio- und Verhaltenstherapie der Schmerzangst und Bewegungsvermeidung sowie interventionelle Verfahren wie die epidurale Rückenmark- oder die Spinalganglienstimulation, wenn die nichtinvasive Therapie versagt.

Schlüsselwörter

Posttraumatische Entzündung Chronischer Schmerz Neuroplastizität Entzündungshemmer Epidurale Rückenmarkstimulation 

Complex regional pain syndrome (CRPS)

An update

Abstract

The acute phase of complex regional pain syndrome (CRPS) is pathophysiologically characterized by an activation of the immune system and its associated inflammatory response. During the course of CRPS, central nervous symptoms like mechanical hyperalgesia, loss of sensation, and body perception disorders develop. Psychological factors such as pain-related anxiety and traumatic events might have a negative effect on the treatment outcome. While the visible inflammatory symptoms improve, the pain often persists. A stage adapted, targeted treatment could improve the prognosis. Effective multidisciplinary treatment includes the following: pharmacotherapy with steroids, bisphosphonates, or dimethylsulfoxide cream (acute phase), and antineuropathic analgesics (all phases); physiotherapy and behavioral therapy for pain-related anxiety and avoidance of movement; and interventional treatment like spinal cord or dorsal root ganglion stimulation if noninvasive options failed.

Keywords

Inflammation, post-traumatic Chronic pain Neuroplacticity Anti-inflammatory agents Spinal cord stimulation, epidural 

Notes

Danksagung

Die Autoren werden durch intramurale Mittel der Universitätsmedizin Mainz und durch Mittel der Berufsgenossenschaft für das Gesundheitswesen (BGW Mainz), Mainz, unterstützt.

Einhaltung ethischer Richtlinien

Interessenkonflikt

V. Dimova und F. Birklein geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Deutsche Schmerzgesellschaft e.V. Published by Springer Medizin Verlag GmbH, ein Teil von Springer Nature - all rights reserved 2018

Authors and Affiliations

  1. 1.Klinik und Poliklinik für NeurologieUniversitätsmedizin der Johannes Gutenberg-Universität MainzMainzDeutschland

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