Zusammenfassung
Die Behandlung chronischer Schmerzen stellt große Herausforderungen an die moderne Medizin. Vor allem das Management von Patienten mit neuropathischen Schmerzen ist mit klassischen Therapieverfahren nur eingeschränkt möglich. Generell beginnt der Behandlungsalgorithmus mit einer ausführlichen Anamnese und einer sorgfältigen körperlichen Untersuchung. Zu den therapeutischen Optionen zählen eine angepasste Pharmakotherapie, diagnostische und therapeutische Infiltrationen und eine psychologische/psychiatrische Vorstellung. Bei nicht ausreichendem Therapieerfolg kommt es zum Einsatz komplexerer Techniken. Hierbei stellt sich die Frage, ob es sich um lokal, regional begrenzte oder multilokuläre therapieresistente Schmerzen handelt. Am Ende dieser Behandlungsmöglichkeiten stehen häufig neuromodulative Therapieverfahren, z. B. die Neurostimulation des Spinalganglions (Dorsal Root Ganglion, DRG), ferner die Rückenmarkstimulation (Spinal Cord Stimulation, SCS) oder die pharmakologische Neuromodulation mittels intrathekaler Pumpen. So können ansonsten austherapierte Schmerzsyndrome, z. B. Failed-Back-Surgery-Syndrom, periphere arterielle Verschlusskrankheit, chronische Angina pectoris und auch Patienten mit Complex-Regional-Pain-Syndrom erfolgreich behandelt werden.
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Schultheis, B.C., Schu, S., Weidle, P.A. (2019). Dorsal-Root-Ganglion-Stimulation. In: Jerosch, J. (eds) Minimalinvasive Wirbelsäulenintervention. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58094-3_24
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