Zusammenfassung
Schmerzen sind Leitsymptom zahlreicher Erkrankungen über alle klinischen Fachgebiete hinweg. Laut aktueller Definition der Neuropathic Pain Special Interest Group der International Association for the Study of Pain sind neuropathische Schmerzen die direkte Folge einer Schädigung oder Erkrankung somatosensorischer Nervenstrukturen im peripheren oder zentralen Nervensystem. Entsprechend Läsionsort wird zwischen peripheren und zentralen neuropathischen Schmerzen unterschieden, wobei im chronischen Schmerzverlauf nicht selten Mischformen anzutreffen sind. Aus pathophysiologischer Sicht gilt zudem, dass jeder Schmerzzustand – unabhängig von der Ursache – in einer Funktion aus Dauer und Intensität strukturelle und funktionelle Veränderungen in schmerzleitenden, -verarbeitenden und -kontrollierenden Nervensystemanteilen nach sich ziehen kann. Diese Phänomene peripherer und zentraler Sensibilisierung werden als Wind-up zusammengefasst. Es resultieren letztlich Schmerzen, die im Zeitverlauf mit immer mehr neuropathischen Komponenten ausgestattet werden und sich zunehmend therapieresistent gegenüber konventionellen Therapiemaßnahmen verhalten. Es kann also in jedem chronischen Schmerzverlauf zum Auftreten neuropathischer Schmerzkomponenten mit entsprechend negativen Konsequenzen hinsichtlich Erkrankungsschwere und Therapierbarkeit kommen. Diesem Umstand wurde mit der Einführung des Mixed-Pain-Konzeptes z. B. für chronische muskuloskelettale Schmerzzustände und mit einer mehrfachen Überarbeitung der Definition und des Gradingsystems neuropathischer Schmerzen unter Einbeziehung sekundär neuropathischer Schmerzzustände Rechnung getragen.
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Wille, C. (2019). Behandlungsalgorithmus beim neuropathischen Schmerzsyndrom. In: Jerosch, J. (eds) Minimalinvasive Wirbelsäulenintervention. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58094-3_3
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