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Diagnostik und Therapie neuropathischer Schmerzen

Diagnostics and therapy of neuropathic pain

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Zusammenfassung

Der neuropathische Schmerz ist ein Schmerz, der durch eine Läsion oder Erkrankung des somatosensorischen Nervensystems verursacht wird. Wissenschaftliche Untersuchungen konnten belegen, dass neuropathische Schmerzen Folge komplex veränderter Signalprozesse im peripheren und im Zentralnervensystem sind. Aktuelle Therapien neuropathischer Schmerzen sind kausal orientiert, haben aber auch symptomatisch die Analgesie durch pharmakologische und nichtpharmakologische Methoden zum Ziel. Weiterhin werden psychologische Schmerzbewältigungstechniken supportiv eingesetzt. Diese Übersicht fasst die zeitgemäße Diagnostik neuropathischer Schmerzen am Beispiel häufiger Erkrankungen zusammen und stellt die Evidenz aus randomisierten kontrollierten Studien zur Therapie neuropathischer Schmerzen vor. Die Behandlungsrichtlinien zur pharmakologischen Beeinflussung neuropathischer Schmerzen umfassen den evidenzbasierten Einsatz von Antidepressiva, Antikonvulsiva, Opioiden, Capsaicin und Lidocain.

Abstract

Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Scientific studies have shown that neuropathic pain is the result of complex altered signalling processes in the peripheral and central nervous system. Current forms of treatment of neuropathic pain are causally oriented but also aim at symptomatic analgesia by pharmacological and nonpharmacological methods. Furthermore, psychological pain management techniques are used in a supportive role. This review summarizes the contemporary diagnostics of neuropathic pain using frequent diseases as examples and presents the evidence from randomized controlled trials on the treatment of neuropathic pain. Treatment guidelines for pharmacological management of neuropathic pain include evidence-based use of antidepressants, anticonvulsants, opioids, capsaicin and lidocaine.

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Authors and Affiliations

  1. Interdisziplinäres UniversitätsSchmerzCentrum, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    G. Gossrau & R. Sabatowski

  2. Klinik und Poliklinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    R. Sabatowski

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  1. G. Gossrau
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  2. R. Sabatowski
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Correspondence to G. Gossrau.

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G. Gossrau und R. Sabatowski geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Gossrau, G., Sabatowski, R. Diagnostik und Therapie neuropathischer Schmerzen. Anaesthesist 70, 993–1002 (2021). https://doi.org/10.1007/s00101-021-01039-x

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