Differentiated diagnostics and multimodal therapy of neuropathic pain. Differenzierte Diagnostik und multimodale Therapie neuropathischer Schmerzen
Karl F. MASUHR1,
1.Former Head of the Department of Neurology, St. Josef–Krankenhaus Zell–Mosel, Germany
Whereas acute pain acts as a warning sign, neuropathic pain loses this protective attribute and develops a self–sustaining chronic course. Almost 33% of the general population report chronic pain and at least 3,3 % neuropathic pain, in Germany ≤ 5 million people. The prevalence is higher in women and increases with age. Neuropathic pain is defined as a direct consequence of a lesion or disease affecting the somatosensory system either at peripheral or central level. Spontaneously occurring dysesthesias, particularly burning pain and repetitive stimulus–triggered neuralgias such as classical trigeminal neuralgia are typical clinical features. Neuropathic pain is frequently found in patients with radiculopathy, nerve compression syndrome and polyneuropathy. The complex regional pain syndrome (CRPS) is associated with abnormal sudomotor, vasomotor and trophic findings as well as psychosomatic symptoms. Frequent reasons for neuropathic pain of CNS origin are cerebral ischemia and traumatic injuries of the spinal cord with phantom pain. Clinical examination, including accurate sensory examination and Quantitative sensory testing (QST), is the basis of pain diagnosis and therapy. It is important to distinguish neuropathic pain from other chronic pain syndromes: Multimodal therapy differs from treatment of nociceptive pain (for example, in most cases of arthropathy), when the nervous system is intact. Drugs of choice are antidepressants and antiepileptics with analgesic properties.
Keywords: chronic pain, neuropathic pain diseases, phantom pain, multimodal therapy
Oryginal language: German