Spezielle Schmerztherapie bei rheumatischen Erkrankungen

Zusammenfassung

Schmerz als Hauptsymptom vieler chronisch-entzündlicher Erkrankungen stellt für den Patienten, aber auch für den behandelnden Arzt besonders in seiner chronifizierten Form eine große Herausforderung dar. Es gibt leider keine „Wunderpille“ mit der man Schmerzen für jeden gleich zuverlässig beseitigen kann. Es gibt aber viele Ansätze pharmakologischer als auch nicht-pharmakologischer Art und deren Kombination, um für den einzelnen Patienten wirksame Behandlungsstrategien zu finden. Um diese Strategien für jeden Patienten individuell optimal festzulegen, bedarf es zum einen eines fundamentierten Wissens über das Spektrum zur Verfügung stehender Mittel, zum anderen aber auch Erkenntnis darüber, wie diese sinnvoll nach Art der vorliegenden Schmerzformen einzusetzen sind. In dieser Übersicht wird beides behandelt, mit einem Fokus auf die medikamentöse Therapie von Schmerzen bei entzündlich-rheumatischen Erkrankungen. Dabei wird herausgearbeitet, dass es für die in diesem Zusammenhang relevantesten Formen des Schmerzes, akut-entzündlich nozizeptiv, neuropathisch und durch periphere und zentrale Sensibilisierung chronifizierte Schmerzen, jeweils andere wirksame Konzepte gibt.

Abstract

Pain is the main symptom of many chronic-inflammatory diseases. Especially in its chronic form, it poses a big challenge for patients and treating physicians. Unfortunately, there is no “magic pill” that would be equally reliable in pain relief for every patient. However, there are a lot of approaches, pharmacologic, non-pharmacologic or both, to find effective treatment strategies for the individual patient. To choose the optimal strategy for each patient, it is not only essential to know about the whole spectrum of options, but also to know how to apply them in the context of different pain profiles. This review covers both aspects, with a focus on, but not limited to, pharmacologic approaches to pain associated with inflammatory rheumatic diseases. It highlights that each form of pain – acute-inflammatory nociceptive pain, neuropathic pain and pain resulting from peripheral and central sensitisation – has its own effective treatment strategy.

Schlüsselwörter

Schmerz - chronisch-entzündlich - Rheumatologie - Schmerztherapie - muskuloskeletal

Key word

pain - chronic-inflammatory - pain therapy - musculoskeletal - rheumatology

Publication History

Article published online:
14 October 2020

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