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Der Schmerz
Erschienen in: Der Schmerz 5/2016

30.08.2016 | Neuropathischer Schmerz | Schwerpunkt

Chronischer Schmerz

Wahrnehmung, Belohnung und neurale Verarbeitung

verfasst von: Dr. S. Becker, Prof. Dr. M. Diers

Erschienen in: Der Schmerz | Ausgabe 5/2016

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Zusammenfassung

Verschiedene chronische Schmerzerkrankungen sind durch Veränderungen in der Wahrnehmung von Schmerzreizen und durch Modifikationen der kortikalen Verarbeitung gekennzeichnet. In diesem Übersichtsbeitrag werden die Veränderungen bei Muskelschmerz und neuropathischem Schmerz dargestellt. Als Beispiele für Muskelschmerz werden Veränderungen bei Patienten mit Fibromyalgie und chronischem Rückenschmerz herangezogen, in Bezug auf neuropathischen Schmerz werden Patienten nach einer Amputation mit Phantomschmerz und Patienten mit komplexem regionalem Schmerzsyndrom betrachtet. Neben Veränderungen der Schmerzwahrnehmung werden zunehmend auch Veränderungen der Belohnungsverarbeitung und deren zugrunde liegende Mechanismen beschrieben. Hier wird dargestellt, wie sich Schmerz und Belohnung gegenseitig beeinflussen. Auch auf die Relevanz solcher Interaktionen für chronischen Schmerz wird eingegangen. Implikationen dieser Erkenntnisse für therapeutische Anwendungen werden anhand von sensorisch-motorischen Trainings sowie verhaltenstherapeutischen Interventionen diskutiert. Der Fokus liegt dabei auf ihrer Wirksamkeit, den Mechanismen und zukünftigen Entwicklungen. Eingegangen wird auf die operante Verhaltenstherapie bei chronischem Rückenschmerz und beim Fibromyalgiesyndrom, auf das Prothesentraining bei Phantomschmerz und auf das Diskriminations-, Spiegel- und Vorstellungstraining bei Phantomschmerz und beim komplexen regionalen Schmerzsyndrom. Im Hinblick auf die zuvor diskutierte Relevanz von Belohnungsprozessen liegt ein Schwerpunkt auf der Rolle von Belohnung und damit assoziiertem Lernen in der Schmerztherapie.
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Metadaten
Titel
Chronischer Schmerz
Wahrnehmung, Belohnung und neurale Verarbeitung
verfasst von
Dr. S. Becker
Prof. Dr. M. Diers
Publikationsdatum
30.08.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Der Schmerz / Ausgabe 5/2016
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI
https://doi.org/10.1007/s00482-016-0149-y

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