Zusammenfassung
In dieser gemeinsamen Leitlinie der im Titel genannten Fachgesellschaften und Arbeitsgruppen wurden evidenzbasierte Empfehlungen für den Einsatz von Screening-Fragebögen und diagnostischen Tests bei Patienten mit neuropathischen Schmerzen entwickelt. Die systematische Literatursuche und Metaanalyse erbrachte folgende Ergebnisse: Von den Screening-Fragebögen erhielten Douleur Neuropathique en 4 Questions (DN4), I‑DN4 (Patientenversion DN4) und das Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) eine starke Empfehlung, und S‑LANSS (Patientenversion LANSS) und painDETECT schwache Empfehlungen für ihre Verwendung im Diagnosepfad für Patienten mit möglichem neuropathischem Schmerz. Es resultierte eine starke Empfehlung für die Verwendung einer Hautbiopsie und eine schwache Empfehlung für die quantitative sensorische Testung und nozizeptiv evozierte Potenziale. Der Stellenwert der konfokalen kornealen Mikroskopie ist noch offen. Funktionelle Bildgebung und periphere Nervenblockaden sind hilfreich bei der Aufklärung der Pathophysiologie, die aktuelle Literatur unterstützt ihre Verwendung zur Diagnose von neuropathischen Schmerzen jedoch nicht. In ausgewählten Fällen kann eine genetische Untersuchung in spezialisierten Zentren in Betracht gezogen werden.
Abstract
In this joint guideline of the scientific societies and working groups mentioned in the title, evidence-based recommendations for the use of screening questionnaires and diagnostic tests in patients with neuropathic pain were developed. The systematic literature search and meta-analysis yielded the following results: Of the screening questionnaires, Douleur Neuropathique en 4 Questions (DN4), I‑DN4 (self-administered DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) received a strong recommendation, while S‑LANSS (self-administered LANSS) and PainDETECT received weak recommendations for their use in the diagnostic workup of patients with possible neuropathic pain. There was a strong recommendation for the use of skin biopsy and a weak recommendation for quantitative sensory testing and nociceptive evoked potentials. The role of confocal corneal microscopy is still unclear. Functional imaging and peripheral nerve blocks are helpful in elucidating the pathophysiology, but current literature does not support their use in diagnosing neuropathic pain. In selected cases, genetic testing in specialized centers may be considered.
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C. Sommer erhielt Honorare für Vorträge und Beratungsleistungen von Algiax Bayer, CSL Behring, Grifols, Kedrion, LFB, Nevro, Omega, Pfizer, Takeda, Teva. Sie erhält Forschungsförderung von der DFG (SFB 1158, KFO 5001 ResolvePain und GRK2660) Approach&Avoidance. R. Baron erhielt Förderungen für EU-Projekte: „Europain“ (115007). DOLORisk (633491), IMI Paincare (777500) sowie vom Bundesministerium für Bildung und Forschung (BMBF) für das Verbundprojekt NoChro (13GW0338C) und das Deutsche Forschungsnetzwerk Neuropathischer Schmerz (01EM0903), sowie Förderungen von Pfizer Pharma GmbH, Sanofi Genzyme GmbH, Grünenthal GmbH, Mundipharma Research GmbH und Co. KG., Alnylam Pharmaceuticals Inc., Zambon GmbH, Sanofi Aventis GmbH, Vortragshonorare von Pfizer Pharma GmbH, Sanofi Genzyme GmbH, Grünenthal GmbH, Mundipharma, Lilly GmbH, Desitin Arzneimittel GmbH, Teva GmbH, Bayer AG, MSD GmbH, Seqirus Australia Pty. Ltd, Novartis Pharma GmbH, TAD Pharma GmbH, Grünenthal SA Portugal, Grünenthal Pharma AG Schweiz, Grünenthal B.V. Niederlande, Evapharma, Takeda Pharmaceuticals International AG Schweiz, Ology Medical Education Netherlands, Ever Pharma GmbH, Amicus Therapeutics GmbH, Novo Nordisk Pharma GmbH, Chiesi GmbH, Stada Mena DWC LLC Dubai, Hexal AG, Viatris, AstraZeneca GmbH, Sandoz und finanzielle Aufwandsentschädigungen für Beratertätigkeiten von Pfizer Pharma GmbH, Sanofi Genzyme GmbH, Grünenthal GmbH, Lilly, Novartis Pharma GmbH, Bristol-Myers Squibb, Biogen, AstraZeneca GmbH, Daiichi Sankyo, Glenmark Pharmaceuticals S.A., Seqirus Australia Pty. Ltd, Teva Pharmaceuticals Europe Niederlande, Teva GmbH, Genentech, Mundipharma International Ltd. UK, Galapagos NV, Kyowa Kirin GmbH, Vertex Pharmaceuticals Inc., Biotest AG, Celgene GmbH, Desitin Arzneimittel GmbH, Regeneron Pharmaceuticals Inc. USA, Theranexus DSV CEA Frankreich, Abbott Products Operations AG Schweiz, Bayer AG, Grünenthal Pharma AG Schweiz, Akcea Therapeutics Germany GmbH, Asahi Kasei Pharma Corporation, AbbVie Deutschland GmbH & Co. KG, Air Liquide Sante International Frankreich, Alnylam Germany GmbH, Lateral Pharma Pty Ltd, Hexal AG, Angelini, Janssen, SIMR Biotech Pty Ltd Australien, Confo Therapeutics N. V. Belgium, Merz Pharmaceuticals GmbH, Neumentum Inc., F. Hoffmann-La Roche Ltd. Switzerland, AlgoTherapeutix SAS France, Nanobiotix SA France, AmacaThera Inc. Canada, Heat2Move, Resano GmbH, Esteve Pharmaceuticals SA. J. Sachau erhielt finanzielle Unterstützung für Kongressreisen von Alnylam Pharmaceuticals Inc. und Pfizer, finanzielle Aufwandsentschädigungen für Beratertätigkeiten von Pfizer Pharma GmbH und Vortragshonorare von Grünenthal GmbH und Alnylam Germany GmbH. E. Enax-Krumova hat eine von der Deutschen Gesetzlichen Unfallversicherung (DGUV) für die Dauer von 6 Jahren (2020–2026) geförderte Stiftungsprofessur inne, erhielt zudem Zuwendungen in Form von Forschungsförderungen von der Georgius Agricola Stiftung Ruhr und DLR e. V., Vergütung für Teilnahme an einer klinischen Studie von Apurano (an die Klinik) sowie Honorare für Vorträge und Beratungsleistungen von Omega Pharma und Novartis (persönlich). Ö.S. Özgül erhielt eine intramurale Förderung durch die Medizinische Fakultät der Ruhr-Universität Bochum (FoRUM Ref. Nr. K120-18). A. Papagianni gibt an, dass kein Interessenkonflikt besteht.
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Sommer, C., Baron, R., Sachau, J. et al. Die EAN-NeuPSIG-Leitlinie zur Diagnostik bei neuropathischen Schmerzen – eine Kurzfassung. Schmerz (2024). https://doi.org/10.1007/s00482-024-00806-0
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DOI: https://doi.org/10.1007/s00482-024-00806-0