Skip to main content
Erschienen in: Die Anaesthesiologie 12/2021

21.10.2021 | Neuropathischer Schmerz | Leitthema

Diagnostik und Therapie neuropathischer Schmerzen

verfasst von: PD Dr. G. Gossrau, R. Sabatowski

Erschienen in: Die Anaesthesiologie | Ausgabe 12/2021

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Attal N, Bouhassira D, Baron R (2018) Diagnosis and assessment of neuropathic pain through questionnaires. Lancet Neurol 17:456–466 PubMed Attal N, Bouhassira D, Baron R (2018) Diagnosis and assessment of neuropathic pain through questionnaires. Lancet Neurol 17:456–466 PubMed
2.
Zurück zum Zitat Attal N, Cruccu G, Baron R et al (2010) EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 17:e1113–e1188 Attal N, Cruccu G, Baron R et al (2010) EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 17:e1113–e1188
3.
Zurück zum Zitat Attal N, De Andrade DC, Adam F et al (2016) Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 15:555–565 PubMed Attal N, De Andrade DC, Adam F et al (2016) Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 15:555–565 PubMed
4.
Zurück zum Zitat Baron R, Maier C, Attal N et al (2017) Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain 158:261–272 PubMed Baron R, Maier C, Attal N et al (2017) Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain 158:261–272 PubMed
5.
Zurück zum Zitat Beloeil H, Sion B, Rousseau C et al (2017) Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol 34:652–657 PubMed Beloeil H, Sion B, Rousseau C et al (2017) Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol 34:652–657 PubMed
6.
Zurück zum Zitat Bendtsen L, Zakrzewska JM, Heinskou TB et al (2020) Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 19:784–796 PubMed Bendtsen L, Zakrzewska JM, Heinskou TB et al (2020) Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 19:784–796 PubMed
7.
Zurück zum Zitat Bennett M (2001) The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92:147–157 PubMed Bennett M (2001) The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92:147–157 PubMed
8.
Zurück zum Zitat Bhaskar A, Bell A, Boivin M et al (2021) Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 3:22 PubMedPubMedCentral Bhaskar A, Bell A, Boivin M et al (2021) Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 3:22 PubMedPubMedCentral
9.
Zurück zum Zitat Bouhassira D, Attal N, Alchaar H et al (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36 PubMed Bouhassira D, Attal N, Alchaar H et al (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36 PubMed
10.
Zurück zum Zitat Bouhassira D, Lanteri-Minet M, Attal N et al (2008) Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 136:380–387 PubMed Bouhassira D, Lanteri-Minet M, Attal N et al (2008) Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 136:380–387 PubMed
11.
Zurück zum Zitat Broggi G, Ferroli P, Franzini A et al (2000) Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:59–64 PubMedPubMedCentral Broggi G, Ferroli P, Franzini A et al (2000) Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:59–64 PubMedPubMedCentral
12.
Zurück zum Zitat Casser HR, Huppe M, Kohlmann T et al (2012) German pain questionnaire and standardised documentation with the KEDOQ-Schmerz. A way for quality management in pain therapy. Schmerz 26:168–175 PubMed Casser HR, Huppe M, Kohlmann T et al (2012) German pain questionnaire and standardised documentation with the KEDOQ-Schmerz. A way for quality management in pain therapy. Schmerz 26:168–175 PubMed
15.
Zurück zum Zitat Chen YK, Boden KA, Schreiber KL (2021) The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review. Anaesthesia 76(Suppl 1):8–17 PubMedPubMedCentral Chen YK, Boden KA, Schreiber KL (2021) The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review. Anaesthesia 76(Suppl 1):8–17 PubMedPubMedCentral
16.
Zurück zum Zitat Cruccu G, Truini A (2017) A review of neuropathic pain: from guidelines to clinical practice. Pain Ther 6:35–42 PubMedPubMedCentral Cruccu G, Truini A (2017) A review of neuropathic pain: from guidelines to clinical practice. Pain Ther 6:35–42 PubMedPubMedCentral
17.
Zurück zum Zitat De Greef BTA, Hoeijmakers JGJ, Geerts M et al (2019) Lacosamide in patients with Nav1.7 mutations-related small fibre neuropathy: a randomized controlled trial. Brain 142:263–275 PubMed De Greef BTA, Hoeijmakers JGJ, Geerts M et al (2019) Lacosamide in patients with Nav1.7 mutations-related small fibre neuropathy: a randomized controlled trial. Brain 142:263–275 PubMed
18.
Zurück zum Zitat Demant DT, Lund K, Vollert J et al (2014) The effect of oxcarbazepine in peripheral neuropathic pain depends on pain phenotype: a randomised, double-blind, placebo-controlled phenotype-stratified study. Pain 155:2263–2273 PubMed Demant DT, Lund K, Vollert J et al (2014) The effect of oxcarbazepine in peripheral neuropathic pain depends on pain phenotype: a randomised, double-blind, placebo-controlled phenotype-stratified study. Pain 155:2263–2273 PubMed
20.
Zurück zum Zitat Dieleman JP, Kerklaan J, Huygen F et al (2008) Incidence rates and treatment of neuropathic pain conditions in the general population. Pain 137:681–688 PubMed Dieleman JP, Kerklaan J, Huygen F et al (2008) Incidence rates and treatment of neuropathic pain conditions in the general population. Pain 137:681–688 PubMed
21.
Zurück zum Zitat Dillmann U, Nilges P, Saile H et al (1994) Assessing disability in chronic pain patients. Schmerz 8:100–110 Dillmann U, Nilges P, Saile H et al (1994) Assessing disability in chronic pain patients. Schmerz 8:100–110
22.
Zurück zum Zitat Farrar JT, Young JP Jr, Lamoreaux L et al (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158 PubMed Farrar JT, Young JP Jr, Lamoreaux L et al (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158 PubMed
23.
Zurück zum Zitat Finnerup NB, Attal N, Haroutounian S et al (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162–173 PubMedPubMedCentral Finnerup NB, Attal N, Haroutounian S et al (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162–173 PubMedPubMedCentral
24.
Zurück zum Zitat Finnerup NB, Haroutounian S, Kamerman P et al (2016) Neuropathic pain: an updated grading system for research and clinical practice. Pain 157:1599–1606 PubMedPubMedCentral Finnerup NB, Haroutounian S, Kamerman P et al (2016) Neuropathic pain: an updated grading system for research and clinical practice. Pain 157:1599–1606 PubMedPubMedCentral
25.
Zurück zum Zitat Fitzcharles MA, Cohen SP, Clauw DJ et al (2021) Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet 397:2098–2110 PubMed Fitzcharles MA, Cohen SP, Clauw DJ et al (2021) Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet 397:2098–2110 PubMed
26.
Zurück zum Zitat Forbes HJ, Thomas SL, Smeeth L et al (2016) A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain 157:30–54 PubMed Forbes HJ, Thomas SL, Smeeth L et al (2016) A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain 157:30–54 PubMed
27.
Zurück zum Zitat Freynhagen R, Baron R, Gockel U et al (2006) painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 22:1911–1920 PubMed Freynhagen R, Baron R, Gockel U et al (2006) painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 22:1911–1920 PubMed
28.
Zurück zum Zitat Freynhagen R, Parada HA, Calderon-Ospina CA et al (2019) Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin 35:1011–1018 PubMed Freynhagen R, Parada HA, Calderon-Ospina CA et al (2019) Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin 35:1011–1018 PubMed
29.
Zurück zum Zitat Gilron I, Tu D, Holden RR et al (2015) Combination of morphine with nortriptyline for neuropathic pain. Pain 156:1440–1448 PubMed Gilron I, Tu D, Holden RR et al (2015) Combination of morphine with nortriptyline for neuropathic pain. Pain 156:1440–1448 PubMed
30.
Zurück zum Zitat Haanpaa M, Attal N, Backonja M et al (2011) NeuPSIG guidelines on neuropathic pain assessment. Pain 152:14–27 PubMed Haanpaa M, Attal N, Backonja M et al (2011) NeuPSIG guidelines on neuropathic pain assessment. Pain 152:14–27 PubMed
31.
Zurück zum Zitat Hauser W, Bock F, Huppe M et al (2020) Recommendations of the second update of the LONTS guidelines : Long-term opioid therapy for chronic noncancer pain. Schmerz 34:204–244 PubMed Hauser W, Bock F, Huppe M et al (2020) Recommendations of the second update of the LONTS guidelines : Long-term opioid therapy for chronic noncancer pain. Schmerz 34:204–244 PubMed
32.
Zurück zum Zitat Holbech JV, Bach FW, Finnerup NB et al (2015) Imipramine and pregabalin combination for painful polyneuropathy: a randomized controlled trial. Pain 156:958–966 PubMed Holbech JV, Bach FW, Finnerup NB et al (2015) Imipramine and pregabalin combination for painful polyneuropathy: a randomized controlled trial. Pain 156:958–966 PubMed
33.
Zurück zum Zitat Ihs (2018) Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1–211 Ihs (2018) Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1–211
34.
Zurück zum Zitat Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126 PubMed Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126 PubMed
35.
Zurück zum Zitat Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625 PubMed Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625 PubMed
37.
Zurück zum Zitat Kuiken TA, Schechtman L, Harden RN (2005) Phantom limb pain treatment with mirtazapine: a case series. Pain Pract 5:356–360 PubMed Kuiken TA, Schechtman L, Harden RN (2005) Phantom limb pain treatment with mirtazapine: a case series. Pain Pract 5:356–360 PubMed
38.
Zurück zum Zitat Labau JIR, Estacion M, Tanaka BS et al (2020) Differential effect of lacosamide on Nav1.7 variants from responsive and non-responsive patients with small fibre neuropathy. Brain 143:771–782 PubMedPubMedCentral Labau JIR, Estacion M, Tanaka BS et al (2020) Differential effect of lacosamide on Nav1.7 variants from responsive and non-responsive patients with small fibre neuropathy. Brain 143:771–782 PubMedPubMedCentral
39.
Zurück zum Zitat Lutz J, Thon N, Stahl R et al (2016) Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict. J Neurosurg 124:823–830 PubMed Lutz J, Thon N, Stahl R et al (2016) Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict. J Neurosurg 124:823–830 PubMed
40.
Zurück zum Zitat Maarbjerg S, Benoliel R (2021) The changing face of trigeminal neuralgia—A narrative review. Headache 61:817–837 PubMed Maarbjerg S, Benoliel R (2021) The changing face of trigeminal neuralgia—A narrative review. Headache 61:817–837 PubMed
41.
Zurück zum Zitat Moisset X, Bouhassira D, Avez Couturier J et al (2020) Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol 176:325–352 PubMed Moisset X, Bouhassira D, Avez Couturier J et al (2020) Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol 176:325–352 PubMed
42.
Zurück zum Zitat Moulin D, Boulanger A, Clark AJ et al (2014) Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag 19:328–335 PubMedPubMedCentral Moulin D, Boulanger A, Clark AJ et al (2014) Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag 19:328–335 PubMedPubMedCentral
43.
Zurück zum Zitat Mu A, Weinberg E, Moulin DE et al (2017) Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician 63:844–852 PubMedPubMedCentral Mu A, Weinberg E, Moulin DE et al (2017) Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician 63:844–852 PubMedPubMedCentral
45.
Zurück zum Zitat Nilges P, Essau C (2015) Depression, anxiety and stress scales: DASS—A screening procedure not only for pain patients. Schmerz 29:649–657 PubMed Nilges P, Essau C (2015) Depression, anxiety and stress scales: DASS—A screening procedure not only for pain patients. Schmerz 29:649–657 PubMed
46.
Zurück zum Zitat Nishihara M, Arai YCP, Yamamoto Y et al (2013) Combinations of low-dose antidepressants and low-dose pregabalin as useful adjuvants to opioids for intractable, painful bone metastases. Pain Phys 16:E547–E552 Nishihara M, Arai YCP, Yamamoto Y et al (2013) Combinations of low-dose antidepressants and low-dose pregabalin as useful adjuvants to opioids for intractable, painful bone metastases. Pain Phys 16:E547–E552
47.
Zurück zum Zitat Ostgathe C, Voltz R, Van Aaaken A et al (2012) Practicability, safety, and efficacy of a „German model“ for opioid conversion to oral levo-methadone. Support Care Cancer 20:2105–2110 PubMed Ostgathe C, Voltz R, Van Aaaken A et al (2012) Practicability, safety, and efficacy of a „German model“ for opioid conversion to oral levo-methadone. Support Care Cancer 20:2105–2110 PubMed
49.
Zurück zum Zitat Petzke F, Karst M, Gastmeier K et al (2019) Position paper on medical cannabis and cannabis-based medicines in pain medicine. Schmerz 33:449–465 PubMed Petzke F, Karst M, Gastmeier K et al (2019) Position paper on medical cannabis and cannabis-based medicines in pain medicine. Schmerz 33:449–465 PubMed
50.
Zurück zum Zitat Pickering G, Lucchini C (2020) Topical treatment of localized neuropathic pain in the elderly. Drugs Aging 37:83–89 PubMed Pickering G, Lucchini C (2020) Topical treatment of localized neuropathic pain in the elderly. Drugs Aging 37:83–89 PubMed
51.
Zurück zum Zitat Pogatzki-Zahn E (2021) Prediction and prevention of chronic postoperative pain. Schmerz 35:30–43 PubMed Pogatzki-Zahn E (2021) Prediction and prevention of chronic postoperative pain. Schmerz 35:30–43 PubMed
52.
Zurück zum Zitat Robertson K, Marshman LAG, Plummer D et al (2019) Effect of gabapentin vs pregabalin on pain intensity in adults with chronic sciatica: a randomized clinical trial. JAMA Neurol 76:28–34 PubMed Robertson K, Marshman LAG, Plummer D et al (2019) Effect of gabapentin vs pregabalin on pain intensity in adults with chronic sciatica: a randomized clinical trial. JAMA Neurol 76:28–34 PubMed
53.
Zurück zum Zitat Rolke R, Baron R, Maier C et al (2006) Quantitative sensory testing in the German research network on neuropathic pain (DFNS): standardized protocol and reference values. Pain 123:231–243 PubMed Rolke R, Baron R, Maier C et al (2006) Quantitative sensory testing in the German research network on neuropathic pain (DFNS): standardized protocol and reference values. Pain 123:231–243 PubMed
54.
Zurück zum Zitat Schlereth T (2020) Guideline „diagnosis and non interventional therapy of neuropathic pain“ of the German Society of Neurology (deutsche Gesellschaft fur Neurologie). Neurol Res Pract 2:16 PubMedPubMedCentral Schlereth T (2020) Guideline „diagnosis and non interventional therapy of neuropathic pain“ of the German Society of Neurology (deutsche Gesellschaft fur Neurologie). Neurol Res Pract 2:16 PubMedPubMedCentral
55.
Zurück zum Zitat Tait RC, Chibnall JT, Krause S (1990) The pain disability index: psychometric properties. Pain 40:171–182 PubMed Tait RC, Chibnall JT, Krause S (1990) The pain disability index: psychometric properties. Pain 40:171–182 PubMed
56.
Zurück zum Zitat Tomasello F, Esposito F, Abbritti RV, Angileri FF, Conti A, Cardali SM, La Torre D (2016) Microvascular decompression for trigeminal neuralgia: technical refinement for complication avoidance. World Neurosurg 94:26–31 PubMed Tomasello F, Esposito F, Abbritti RV, Angileri FF, Conti A, Cardali SM, La Torre D (2016) Microvascular decompression for trigeminal neuralgia: technical refinement for complication avoidance. World Neurosurg 94:26–31 PubMed
57.
Zurück zum Zitat Van Seventer R, Vos C, Meerding W et al (2010) Linguistic validation of the DN4 for use in international studies. Eur J Pain 14:58–63 PubMed Van Seventer R, Vos C, Meerding W et al (2010) Linguistic validation of the DN4 for use in international studies. Eur J Pain 14:58–63 PubMed
58.
Zurück zum Zitat Vollert J, Magerl W, Baron R et al (2018) Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models. Pain 159:1090–1102 PubMed Vollert J, Magerl W, Baron R et al (2018) Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models. Pain 159:1090–1102 PubMed
60.
Zurück zum Zitat Ziegler D (2008) Painful diabetic neuropathy: treatment and future aspects. Diabetes Metab Res Rev 24(Suppl 1):S52–S57 PubMed Ziegler D (2008) Painful diabetic neuropathy: treatment and future aspects. Diabetes Metab Res Rev 24(Suppl 1):S52–S57 PubMed
Metadaten
Titel
Diagnostik und Therapie neuropathischer Schmerzen
verfasst von
PD Dr. G. Gossrau
R. Sabatowski
Publikationsdatum
21.10.2021
Verlag
Springer Medizin
Erschienen in
Die Anaesthesiologie / Ausgabe 12/2021
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-021-01039-x

Weitere Artikel der Ausgabe 12/2021

Die Anaesthesiologie 12/2021 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.