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Der Schmerz

, Volume 10, Issue 3, pp 121–129 | Cite as

Die exterozeptive Suppression der Aktivität des M. temporalis in der Analyse von Schmerzmechanismen

  • H. Göbel
  • M. Dworschak
  • P. Kropp
  • A. Heinze
  • D. Heuss
Übersichten

Zusammenfassung

Bei Reizung von Afferenzen des N. trigeminus wird die Willküraktivität der Kaumuskulatur typischerweise in 2 aufeinanderfolgenden Phasen (ES1 und ES2) gehemmt. Die erste Hemmphase wird frühe exterozeptive Suppressionsphase (ES1), die zweite Hemmphase späte exterozeptive Suppressionsphase (ES2) genannt. Die zwischen den beiden Suppressionsperioden gelegene Phase wird als Fazilitationsperiode (FP) bezeichnet. In der Regel ist dieses Suppressionsverhalten bei exterozeptiver Reizung bei Gesunden regelmäßig auslösbar. Zwar kann der Reflex auch mit nicht schmerzhaften Reizen ausgelöst werden, das Antwortverhalten ist jedoch bei Einsatz von schmerzhaften Reizen maximal. Aufgrund dieses Zusammenhangs zwischen Reizintensität, Schmerzwahrnehmung und Reflexantwort wird der Reflex als antinozizeptive Reaktion angesehen. Chronische Schmerzerkrankungen wie der chronische Kopfschmerz vom Spannungstyp und die Migräne ohne Aura gehen mit Veränderungen im normalen Ableitbild der ES einher. Ebenso läßt sich die Ausprägung der ES durch unterschiedliche, in der Schmerztherapie angewandte Substanzen wie z. B. Serotoninagonisten-oder antagonisten, Acetylsalicylsäure oder Naloxon beeinflussen. In dieser Übersicht werden die verschiedenen Einflußgrößen auf die ES-Reflexantwort systematisch aufgezeigt. Darauf aufbauend wird die diagnostische Bedeutung dieser Veränderungen für pathophysiologische Vorgänge in der Schmerzverarbeitung und bei Schmerzerkrankungen dargelegt.

Schlüsselwörter

Exterozeptive Suppression M. temporalis Hirnstammreflexe Schmerzverarbeitung Antinozizeptive Mechanismen 

Exteroceptive suppression of activity of the temporal muscle in analysis of pain mechanisms

Abstract

Stimulating afferent fibers of the trigeminal nerve usually causes two successive suppressions (ES1 and ES2) of the voluntary muscle activity of chewing muscles. The first phase of decreased voluntary activity is called the early exteroceptive suppression period (ES1); the second phase is called the late exteroceptive suppression period (ES2). Between these two suppression periods is a phase of increased muscle activity, the so-called facilitation period (FP). Usually, in healthy subjects this normal pattern of exteroceptive suppression can be elicited regularly. The reflex answer may occur at low non-painful stimulus intensities; however, typically it appears to be most pronounced with high-intensity stimuli. Because of the obvious relationship between stimulus intensity, pain perception and reflex answer, the reflex is regarded as an antinociceptive reaction. Chronic pain syndromes like chronic tension-type headache and migraine without aura cause changes within the normal ES recording pattern. Furthermore, some substances used in pain therapy such as serotoninagonists or antagonists, acetylsalicylic acid or naloxon may also alter the general appearance of the ES. In this review different parameters that influence the ES reflex answer are summarized. Above, the diagnostic value of the changes of the ES for pathophysiological procedures regarding pain perception and pain processing in certain pain diseases is discussed.

Key words

Exteroceptive suppression Temporalis muscle Brain stem reflexes Pain processing Antinociceptive mechanisms 

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Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • H. Göbel
    • 1
  • M. Dworschak
    • 1
  • P. Kropp
    • 1
  • A. Heinze
    • 1
  • D. Heuss
    • 1
  1. 1.Klinik für Neurologie der ChristianAlbrechts-Universität KielKiel

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