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Schmerztherapie bei lebensbedrohlichen und lebenslimitierenden Erkrankungen

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Schmerztherapie bei Kindern, Jugendlichen und jungen Erwachsenen

Zusammenfassung

In den europäischen Ländern nehmen lebenslimitierende Erkrankungen im Kindes- und Jugendalter zu. Die Beurteilung und Therapie der Schmerzen sollte auf Basis des Total Pain Concepts geschehen und physische, psychische, soziale sowie spirituelle Aspekte berücksichtigen. Die Schmerzerfassung ist bei nicht-verbal kommunizierenden Patienten mit schwerer Mehrfachbehinderung eine besondere Herausforderung. Bei Nozizeptorschmerzen sollten Opioide und Nicht-Opioide kombiniert werden, wie dies das WHO Stufenschema beschreibt. Retardiertes Morphin in Granulatform ist für Kinder besonders geeignet. Adjuvanzien kommen bei neuropathischen Schmerzen zum Einsatz. Es sollte die am wenigsten invasive Applikationsform gewählt werden. Die Medikamentendosierung erfolgt auf Basis des Körpergewichts. Neurologisch kranke Kinder reagieren besonders sensibel auf starke Opioide, so dass eine Dosisanpassung nach unten erfolgen muss. Mögliche Nebenwirkungen der Analgetikatherapie müssen antizipiert werden. Die PCA ist eine wichtige Therapieoption, auch bei der häuslichen Versorgung.

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  1. Vestische Kinder- und Jugendklinik Datteln – Universität Witten/Herdecke, Deutsches Kinderschmerzzentrum und Kinderpalliativzentrum, Dr.-Friedrich-Steiner-Straße 5, 45711, Datteln, Deutschland

    Prof. Dr. med. Boris Zernikow

  2. Vestische Kinder- und Jugendklinik Datteln – Universität Witten/Herdecke, Deutsches Kinderschmerzzentrum und Kinderpalliativzentrum, Dr.-Friedrich-Steiner-Straße 5, 45711, Datteln, Deutschland

    Dr. med. Carola Hasan

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    Boris Zernikow

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Zernikow, B., Hasan, C. (2015). Schmerztherapie bei lebensbedrohlichen und lebenslimitierenden Erkrankungen. In: Zernikow, B. (eds) Schmerztherapie bei Kindern, Jugendlichen und jungen Erwachsenen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45057-4_21

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