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2019 | Schmerzsyndrome | OriginalPaper | Buchkapitel

8. Vom Schmerzsyndrom zur Schmerztherapie

verfasst von : Janne Gierthmühlen, Ralf Baron

Erschienen in: Praktische Schmerzmedizin

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Schmerzen sind im Akutstadium eine protektive Reaktion des Körpers, um sich vor potenziellen Gewebeschädigungen zu schützen. An dieser protektiven Reaktion sind sowohl sensorische Afferenzen als auch somatische und vegetative motorische Efferenzen beteiligt. Daneben spielen assoziierte kognitive, affektive und endokrine Komponenten eine Rolle. Akutschmerzen sind häufig vorübergehender Natur und lassen sich einer Ursache zuordnen, die kausal oder symptomatisch behandelt werden kann. Chronische Schmerzen dagegen unterliegen nicht mehr physiologischen protektiven Reaktionen des Körpers. Sie stellen eine eigenständige Schmerzkrankheit dar.
Literatur
Zurück zum Zitat Baron R (2006) Mechanisms of disease; neuropathic pain – a clinical perspective. Nat Clin Pract Neurol 2:95–106PubMedCrossRef Baron R (2006) Mechanisms of disease; neuropathic pain – a clinical perspective. Nat Clin Pract Neurol 2:95–106PubMedCrossRef
Zurück zum Zitat Baron R, Binder A, Wasner G (2010) Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 9:807–819PubMedCrossRef Baron R, Binder A, Wasner G (2010) Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 9:807–819PubMedCrossRef
Zurück zum Zitat Baron R, Förster M, Binder A (2012) Subgrouping of patients with neuropathic pain according to pain-related sensory abnormalities: a first step to a stratified treatment approach. Lancet Neurol 11:999–1005PubMedCrossRef Baron R, Förster M, Binder A (2012) Subgrouping of patients with neuropathic pain according to pain-related sensory abnormalities: a first step to a stratified treatment approach. Lancet Neurol 11:999–1005PubMedCrossRef
Zurück zum Zitat Baron R, Maier C et al (2017) Peripheral neuropathic pain: a mechanism-related organizing principle based on somatosensory profiles. Pain 158(2):261–272CrossRefPubMed Baron R, Maier C et al (2017) Peripheral neuropathic pain: a mechanism-related organizing principle based on somatosensory profiles. Pain 158(2):261–272CrossRefPubMed
Zurück zum Zitat Caterina MJ, Leffler A et al (2000) Impaired nociception and pain sensation in mice lacking the capsaicin receptor. Science 288(5464):306–313PubMedCrossRef Caterina MJ, Leffler A et al (2000) Impaired nociception and pain sensation in mice lacking the capsaicin receptor. Science 288(5464):306–313PubMedCrossRef
Zurück zum Zitat Coull JA, Boudreau D et al (2003) Trans-synaptic shift in anion gradient in spinal lamina I neurons as a mechanism of neuropathic pain. Nature 424:938–942PubMedCrossRef Coull JA, Boudreau D et al (2003) Trans-synaptic shift in anion gradient in spinal lamina I neurons as a mechanism of neuropathic pain. Nature 424:938–942PubMedCrossRef
Zurück zum Zitat Coull JA, Beggs S et al (2005) BDNF from microglia causes the shift in neuronal anion gradient underlying neuropathic pain. Nature 438:1017–1021CrossRefPubMed Coull JA, Beggs S et al (2005) BDNF from microglia causes the shift in neuronal anion gradient underlying neuropathic pain. Nature 438:1017–1021CrossRefPubMed
Zurück zum Zitat Craig AD, Bushnell MC (1994) The thermal grill illusion: unmasking the burn of cold pain. Science 265:252–255PubMedCrossRef Craig AD, Bushnell MC (1994) The thermal grill illusion: unmasking the burn of cold pain. Science 265:252–255PubMedCrossRef
Zurück zum Zitat DeLeo JA, Yezierski RP (2001) The role of neuroinflammation and neuroimmune activation in persistent pain. Pain 90:1–6PubMedCrossRef DeLeo JA, Yezierski RP (2001) The role of neuroinflammation and neuroimmune activation in persistent pain. Pain 90:1–6PubMedCrossRef
Zurück zum Zitat Demant DT, Lund K 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(11):2263–2273PubMedCrossRef Demant DT, Lund K 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(11):2263–2273PubMedCrossRef
Zurück zum Zitat Demant DT, Lund K et al (2015) Pain relief with lidocaine 5 % patch in localized peripheral neuropathic pain in relation to pain phenotype: a randomized, double-blind, and placebo-controlled, phenotype panel study. Pain 156(11):2234–2244PubMedCrossRef Demant DT, Lund K et al (2015) Pain relief with lidocaine 5 % patch in localized peripheral neuropathic pain in relation to pain phenotype: a randomized, double-blind, and placebo-controlled, phenotype panel study. Pain 156(11):2234–2244PubMedCrossRef
Zurück zum Zitat Facer P, Casula MA, Smith GD, Benham CD, Chessell IP, Bountra C, Sinisi M, Birch R, Anand P (2007) Differential expression of the capsaicin receptor TRPV1 and related novel receptors TRPV3, TRPV4 and TRPM8 in normal human tissues and changes in traumatic and diabetic neuropathy. BMC Neurol 7:11PubMedPubMedCentralCrossRef Facer P, Casula MA, Smith GD, Benham CD, Chessell IP, Bountra C, Sinisi M, Birch R, Anand P (2007) Differential expression of the capsaicin receptor TRPV1 and related novel receptors TRPV3, TRPV4 and TRPM8 in normal human tissues and changes in traumatic and diabetic neuropathy. BMC Neurol 7:11PubMedPubMedCentralCrossRef
Zurück zum Zitat Fields HL, Rowbotham M et al (1998) Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis 5:209–227PubMedCrossRef Fields HL, Rowbotham M et al (1998) Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis 5:209–227PubMedCrossRef
Zurück zum Zitat Geber C, Magerl W, Fondel R, Fechir M, Rolke R, Vogt T, Treede RD, Birklein F (2008) Numbness in clinical and experimental pain – a cross-sectional study exploring the mechanisms of reduced tactile function. Pain 139:73–81PubMedCrossRef Geber C, Magerl W, Fondel R, Fechir M, Rolke R, Vogt T, Treede RD, Birklein F (2008) Numbness in clinical and experimental pain – a cross-sectional study exploring the mechanisms of reduced tactile function. Pain 139:73–81PubMedCrossRef
Zurück zum Zitat Hains BC, Saab CY et al (2004) Altered sodium channel expression in second-order spinal sensory neurons contributes to pain after peripheral nerve injury. J Neurosci 24:4832–4839PubMedCrossRefPubMedCentral Hains BC, Saab CY et al (2004) Altered sodium channel expression in second-order spinal sensory neurons contributes to pain after peripheral nerve injury. J Neurosci 24:4832–4839PubMedCrossRefPubMedCentral
Zurück zum Zitat Hong S, Wiley JW (2005) Early painful diabetic neuropathy is associated with differential changes in the expression and function of vanilloid receptor 1. J Biol Chem 280:618–627PubMedCrossRef Hong S, Wiley JW (2005) Early painful diabetic neuropathy is associated with differential changes in the expression and function of vanilloid receptor 1. J Biol Chem 280:618–627PubMedCrossRef
Zurück zum Zitat Hudson LJ, Bevan S et al (2001) VR1 protein expression increases in undamaged DRG neurons after partial nerve injury. Eur J Neurosci 13:2105–2114PubMedCrossRef Hudson LJ, Bevan S et al (2001) VR1 protein expression increases in undamaged DRG neurons after partial nerve injury. Eur J Neurosci 13:2105–2114PubMedCrossRef
Zurück zum Zitat Jänig W (2008) Autonomic nervous system and pain. In: Basbaum AI, Kaneko A, Shepherd GM, Westheimer G (Hrsg) The senses: a comprehensive reference, vol 5: pain. Elsevier Academic Press, San Diego, S 193–226CrossRef Jänig W (2008) Autonomic nervous system and pain. In: Basbaum AI, Kaneko A, Shepherd GM, Westheimer G (Hrsg) The senses: a comprehensive reference, vol 5: pain. Elsevier Academic Press, San Diego, S 193–226CrossRef
Zurück zum Zitat Ji RR, Woolf CJ (2001) Neuronal plasticity and signal transduction in nociceptive neurons: implications for the initiation and maintenance of pathological pain. Neurobiol Dis 8:1–10PubMedCrossRef Ji RR, Woolf CJ (2001) Neuronal plasticity and signal transduction in nociceptive neurons: implications for the initiation and maintenance of pathological pain. Neurobiol Dis 8:1–10PubMedCrossRef
Zurück zum Zitat Johanek L, Shim B, Meyer A (2006) Primary hyperalgesia and nociceptor sensitization. In: Cevero F, Jensen TS (Hrsg) Handbook of clinical neurology, vol 81 (3rd series). Elsevier B.V, Amsterdam, S 35–47 Johanek L, Shim B, Meyer A (2006) Primary hyperalgesia and nociceptor sensitization. In: Cevero F, Jensen TS (Hrsg) Handbook of clinical neurology, vol 81 (3rd series). Elsevier B.V, Amsterdam, S 35–47
Zurück zum Zitat Konopka KH, Harbers M et al (2012) Bilateral sensory abnormalities in patients with unilateral neuropathic pain; a quantitative sensory testing (QST) study. PLoS One 7(5):e37524PubMedPubMedCentralCrossRef Konopka KH, Harbers M et al (2012) Bilateral sensory abnormalities in patients with unilateral neuropathic pain; a quantitative sensory testing (QST) study. PLoS One 7(5):e37524PubMedPubMedCentralCrossRef
Zurück zum Zitat Lai JJ, Hunter C et al (2003) The role of voltage-gated sodium channels in neuropathic pain. Curr Opin Neurobiol 13:291–297PubMedCrossRef Lai JJ, Hunter C et al (2003) The role of voltage-gated sodium channels in neuropathic pain. Curr Opin Neurobiol 13:291–297PubMedCrossRef
Zurück zum Zitat Loeser JD, Ward AA Jr, White LE Jr (1968) Deafferentiation of the -human spinal cord neurons. J Neurosurg 29:48–50PubMedCrossRef Loeser JD, Ward AA Jr, White LE Jr (1968) Deafferentiation of the -human spinal cord neurons. J Neurosurg 29:48–50PubMedCrossRef
Zurück zum Zitat Lombard MC, Larabi Y (1983) Electrophysiological study of cervical dorsal horn cells in partially deafferented rats. In: Bonica JJ (Hrsg) Advances in pain research and therapy. Raven, New York, S 147–154 Lombard MC, Larabi Y (1983) Electrophysiological study of cervical dorsal horn cells in partially deafferented rats. In: Bonica JJ (Hrsg) Advances in pain research and therapy. Raven, New York, S 147–154
Zurück zum Zitat Luo ZD, Chaplan SR et al (2001) Upregulation of dorsal root ganglion (alpha)2 (delta) calcium channel subunit and its correlation with allodynia in spinal nerve-injured rats. J Neurosci 21:1868–1875PubMedCrossRefPubMedCentral Luo ZD, Chaplan SR et al (2001) Upregulation of dorsal root ganglion (alpha)2 (delta) calcium channel subunit and its correlation with allodynia in spinal nerve-injured rats. J Neurosci 21:1868–1875PubMedCrossRefPubMedCentral
Zurück zum Zitat Maier C, Baron R, Tölle T et al (2012) Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain 150:439–450CrossRef Maier C, Baron R, Tölle T et al (2012) Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain 150:439–450CrossRef
Zurück zum Zitat Marchand F, Perretti M et al (2005) Role of the immune system in chronic pain. Nat Rev Neurosci 6:521–532PubMedCrossRef Marchand F, Perretti M et al (2005) Role of the immune system in chronic pain. Nat Rev Neurosci 6:521–532PubMedCrossRef
Zurück zum Zitat McKemy DD, Neuhausser WM et al (2002) Identification of a cold receptor reveals a general role for TRP channels in thermosensation. Nature 416:52–58PubMedCrossRef McKemy DD, Neuhausser WM et al (2002) Identification of a cold receptor reveals a general role for TRP channels in thermosensation. Nature 416:52–58PubMedCrossRef
Zurück zum Zitat McMahon SB, Cafferty WB et al (2005) Immune and glial cell factors as pain mediators and modulators. Exp Neurol 192:444–462PubMedCrossRef McMahon SB, Cafferty WB et al (2005) Immune and glial cell factors as pain mediators and modulators. Exp Neurol 192:444–462PubMedCrossRef
Zurück zum Zitat Milligan ED, O’Connor KA et al (2001) Intrathecal HIV-1 envelope glycoprotein gp120 induces enhanced pain states mediated by spinal cord proinflammatory cytokines. J Neurosci 21:2808–2819PubMedCrossRefPubMedCentral Milligan ED, O’Connor KA et al (2001) Intrathecal HIV-1 envelope glycoprotein gp120 induces enhanced pain states mediated by spinal cord proinflammatory cytokines. J Neurosci 21:2808–2819PubMedCrossRefPubMedCentral
Zurück zum Zitat Nickel FT, Seifert F et al (2011) Mechanisms of neuropathic pain. Eur Neuropsychopharmacol 22:81–91PubMedCrossRef Nickel FT, Seifert F et al (2011) Mechanisms of neuropathic pain. Eur Neuropsychopharmacol 22:81–91PubMedCrossRef
Zurück zum Zitat Nystrom B, Hagbarth KE (1981) Microelectrode recordings from transected nerves in amputees with phantom limb pain. Neurosci Lett 27:211–216PubMedCrossRef Nystrom B, Hagbarth KE (1981) Microelectrode recordings from transected nerves in amputees with phantom limb pain. Neurosci Lett 27:211–216PubMedCrossRef
Zurück zum Zitat Oaklander AL, Brown JM (2004) Unilateral nerve injury produces bilateral loss of distal innervation. Ann Neurol 55:639–644PubMedCrossRef Oaklander AL, Brown JM (2004) Unilateral nerve injury produces bilateral loss of distal innervation. Ann Neurol 55:639–644PubMedCrossRef
Zurück zum Zitat Oaklander AL, Romans K et al (1998) Unilateral postherpetic neuralgia is associated with bilateral sensory neuron damage. Ann Neurol 44:789–795PubMedCrossRef Oaklander AL, Romans K et al (1998) Unilateral postherpetic neuralgia is associated with bilateral sensory neuron damage. Ann Neurol 44:789–795PubMedCrossRef
Zurück zum Zitat Obata K, Katsura H et al (2005) TRPA1 induced in sensory neurons contributes to cold hyperalgesia after inflammation and nerve injury. J Clin Invest 115:2393–2401PubMedPubMedCentralCrossRef Obata K, Katsura H et al (2005) TRPA1 induced in sensory neurons contributes to cold hyperalgesia after inflammation and nerve injury. J Clin Invest 115:2393–2401PubMedPubMedCentralCrossRef
Zurück zum Zitat Ochoa JL, Yarnitsky D (1993) Mechanical hyperalgesias in neuropathic pain patients: dynamic and static subtypes. Ann Neurol 33:465–472PubMedCrossRef Ochoa JL, Yarnitsky D (1993) Mechanical hyperalgesias in neuropathic pain patients: dynamic and static subtypes. Ann Neurol 33:465–472PubMedCrossRef
Zurück zum Zitat Ochoa J, Torebjörk HE et al (1982) Abnormal spontaneous activity in single sensory nerve fibers in humans. Muscle Nerve 5(9S):S74–S77PubMed Ochoa J, Torebjörk HE et al (1982) Abnormal spontaneous activity in single sensory nerve fibers in humans. Muscle Nerve 5(9S):S74–S77PubMed
Zurück zum Zitat Omana-Zapata I, Khabbaz MA et al (1997) Tetrodotoxin inhibits neuropathic ectopic activity in neuromas, dorsal root ganglia and dorsal horn neurons. Pain 72:41–49PubMedCrossRef Omana-Zapata I, Khabbaz MA et al (1997) Tetrodotoxin inhibits neuropathic ectopic activity in neuromas, dorsal root ganglia and dorsal horn neurons. Pain 72:41–49PubMedCrossRef
Zurück zum Zitat Ossipov MH, Porreca F (2006) Descending excitatory systems. In: Cevero F, Jensen TS (Hrsg) Handbook of clinical neurology, vol 81 (3rd series). Elsevier B.V, Amsterdam, S 193–210 Ossipov MH, Porreca F (2006) Descending excitatory systems. In: Cevero F, Jensen TS (Hrsg) Handbook of clinical neurology, vol 81 (3rd series). Elsevier B.V, Amsterdam, S 193–210
Zurück zum Zitat Pertovaara A, Almeida A (2006) Descending inhibitory systems. In: Cevero F, Jensen TS (Hrsg) Handbook of clinical neurology, vol 81 (3rd series). Elsevier B.V, Amsterdam, S 179–192 Pertovaara A, Almeida A (2006) Descending inhibitory systems. In: Cevero F, Jensen TS (Hrsg) Handbook of clinical neurology, vol 81 (3rd series). Elsevier B.V, Amsterdam, S 179–192
Zurück zum Zitat Polgar E, Gray S et al (2004) Lack of evidence for significant neuronal loss in laminae I-III of the spinal dorsal horn of the rat in the chronic constriction injury model. Pain 111:144–150PubMedCrossRef Polgar E, Gray S et al (2004) Lack of evidence for significant neuronal loss in laminae I-III of the spinal dorsal horn of the rat in the chronic constriction injury model. Pain 111:144–150PubMedCrossRef
Zurück zum Zitat Price MP, McIlwrath SL et al (2001) The DRASIC cation channel contributes to the detection of cutaneous touch and acid stimuli in mice. Neuron 32:1071–1083PubMedCrossRef Price MP, McIlwrath SL et al (2001) The DRASIC cation channel contributes to the detection of cutaneous touch and acid stimuli in mice. Neuron 32:1071–1083PubMedCrossRef
Zurück zum Zitat Reimer M, Rempe T, Diedrichs C, Baron R, Gierthmühlen J (2016) Sensitization of the nociceptive system in complex regional pain syndrome. PLoSOne 11(5):e0154553CrossRef Reimer M, Rempe T, Diedrichs C, Baron R, Gierthmühlen J (2016) Sensitization of the nociceptive system in complex regional pain syndrome. PLoSOne 11(5):e0154553CrossRef
Zurück zum Zitat Shamash S, Reichert F et al (2002) The cytokine network of Wallerian degeneration: tumor necrosis factor-alpha, interleukin-1alpha, and interleukin-1beta. J Neurosci 22:3052–3060PubMedCrossRefPubMedCentral Shamash S, Reichert F et al (2002) The cytokine network of Wallerian degeneration: tumor necrosis factor-alpha, interleukin-1alpha, and interleukin-1beta. J Neurosci 22:3052–3060PubMedCrossRefPubMedCentral
Zurück zum Zitat Tal M, Bennett GJ (1994) Extra-territorial pain in rats with a peripheral mononeuropathy: mechano-hyperalgesia and mechano-allodynia in the territory of an uninjured nerve. Pain 57:375–382PubMedCrossRef Tal M, Bennett GJ (1994) Extra-territorial pain in rats with a peripheral mononeuropathy: mechano-hyperalgesia and mechano-allodynia in the territory of an uninjured nerve. Pain 57:375–382PubMedCrossRef
Zurück zum Zitat Vetter I, Deuis JR et al (2017) Nav1.7 as a pain target – from gene to pharmacology. Pharmacol Ther 172:73–100PubMedCrossRef Vetter I, Deuis JR et al (2017) Nav1.7 as a pain target – from gene to pharmacology. Pharmacol Ther 172:73–100PubMedCrossRef
Zurück zum Zitat Watkins LR, Milligan ED et al (2001a) Glial activation: a driving force for pathological pain. Trends Neurosci 24:450–455PubMedCrossRef Watkins LR, Milligan ED et al (2001a) Glial activation: a driving force for pathological pain. Trends Neurosci 24:450–455PubMedCrossRef
Zurück zum Zitat Watkins LR, Milligan ED et al (2001b) Spinal cord glia: new players in pain. Pain 93:201–205PubMedCrossRef Watkins LR, Milligan ED et al (2001b) Spinal cord glia: new players in pain. Pain 93:201–205PubMedCrossRef
Zurück zum Zitat Wieseler-Frank J, Maier SF et al (2004) Glial activation and pathological pain. Neurochem Int 45:389–395PubMedCrossRef Wieseler-Frank J, Maier SF et al (2004) Glial activation and pathological pain. Neurochem Int 45:389–395PubMedCrossRef
Zurück zum Zitat Wood JN, Boorman JP et al (2004) Voltage-gated sodium channels and pain pathways. J Neurobiol 61:55–71PubMedCrossRef Wood JN, Boorman JP et al (2004) Voltage-gated sodium channels and pain pathways. J Neurobiol 61:55–71PubMedCrossRef
Zurück zum Zitat Yarnitsky D, Granot M et al (2012) Conditioned pain modulation predicts duloxetine efficacy in painful diabetic neuropathy. Pain 153:1193–1198PubMedCrossRef Yarnitsky D, Granot M et al (2012) Conditioned pain modulation predicts duloxetine efficacy in painful diabetic neuropathy. Pain 153:1193–1198PubMedCrossRef
Metadaten
Titel
Vom Schmerzsyndrom zur Schmerztherapie
verfasst von
Janne Gierthmühlen
Ralf Baron
Copyright-Jahr
2019
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-57487-4_7

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