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Diagnostik der endogenen Schmerzhemmkapazität und der Schmerzempfindlichkeit

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Schmerztherapie ohne Medikamente

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Zusammenfassung

Die Schmerzhemmung kann mit quantitativen sensorischen Tests und speziell mit dem psychophysiologischen Paradigma „conditioned pain modulation“ (CPM) geprüft werden. Ein konditionierender Reiz aktiviert die Schmerzhemmung, und ein sensorischer Testreiz prüft das Ausmaß. Unter dem „cold pressure test“ liefern Druck- und Hitzetestreize die sichersten Ergebnisse. Gut erkennbare Einflussfaktoren sind zu beachten. Das Risiko bzw. der Stand der Chronifizierung und der Therapieverlauf sind mit der Schmerzempfindlichkeit und -toleranz, der CPM und der „exercise induced hypoalgesia“ einschätzbar. Bei Gesunden sind die Schmerzschwellen und die -toleranz hoch, und physische Belastungen sorgen für eine „exercise induced hypoalgesia“. Schmerzsensibilisierung senkt die Wahrnehmungsgrenze. Physische Belastungen lösen noch eine geringere Hypoalgesie oder eine paradoxe Reaktion aus. Die Offset-Analgesie, die zeitliche Summation von Hitzereizen und der nozizeptive R-III-Reflex sind weitere diagnostische Werkzeuge.

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  1. Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland

    Wolfgang Laube

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  1. Wolfgang Laube
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© 2022 Der/die Autor(en), exklusiv lizenziert durch Springer-Verlag GmbH, DE, ein Teil von Springer Nature

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Laube, W. (2022). Diagnostik der endogenen Schmerzhemmkapazität und der Schmerzempfindlichkeit. In: Schmerztherapie ohne Medikamente. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-63846-0_7

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  • DOI: https://doi.org/10.1007/978-3-662-63846-0_7

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