Kopf- und Gesichtsschmerzen: Somatosensorische Verzerrungen erkennen und gezielt behandeln

Eine Kombination aus Pain Neuroscience Education (PNE), systematischem sensomotorischem Training (SSMT) und systematischem Gehirntraining (SGT) stellt einen systematischen Therapieansatz bei Kopf- und Gesichtsschmerzen dar. Anhand eines Fallbeispiels wird die praktische Umsetzung dieses Konzepts veranschaulicht. Die Ergebnisse zeigen, dass durch die gezielte Behandlung somatosensorischer Verzerrungen nicht nur die Schmerzwahrnehmung reduziert, sondern auch die emotionale Resilienz und funktionelle Kapazität der Betroffenen verbessert werden kann. Dieser Artikel ist der 3. und letzte Teil der Serie zu somatosensorischen Verzerrungen bei Kopf- und Gesichtsschmerzen in den Schmerzseiten der MSK.

• Literatur

• 1 Louw A, Zimney K, O’Hotto C. et al. The clinical application of teaching people about pain. Physiother Theory Pract 2016; 32: 385-395
• 2 Louw A, Diener I, Butler DS. et al. The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress in Chronic Musculoskeletal Pain. Arch Phys Med Rehabil 2011; 92: 2041-2056
• 3 Louw A, Zimney K, Puentedura EJ. et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract 2016; 32: 332-355
• 4 Lorimer Moseley G, Leake HB, Beetsma AJ. et al. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. J Pain 2024; 25: 104425
• 5 Leake HB, Moseley GL, Stanton TR. et al. What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education. Pain 2021; 162: 2558-2568
• 6 Meise R, Carvalho GF, Thiel C. et al. Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial. Cephalalgia 2023; 43: 3331024221144781
• 7 von Piekartz H, Geitner G, Möller D. et al. Does combined individualized orofacial manual therapy, pain neuroscience education, and brain training change orofacial pain, chronic face dysfunction, (facial) body perception and pain? An observational mixed methods case series study. J Man Manip Ther 2022; 30: 180-191
• 8 Wolf E, Birgerstam P, Nilner M. et al. Nonspecific chronic orofacial pain: studying patient experiences and perspectives with a qualitative approach. J Orofac Pain 2008; 22: 349-358
• 9 Mohr G. A qualitative study on pain experiences and pain behavior in patients with chronic facial pain. Zeitschrift für kraniomandibuläre Funktion 2011; 3: 9-28
• 10 von Piekartz H, Paris-Alemany A. Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review. Applied Sciences 2021; 11: 6857
• 11 Dilek B, Ayhan C, Yagci G. et al. Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial. J Hand Ther 2018; 31: 2-9.e1
• 12 Xia M, Xu P, Yang Y. et al. Frontoparietal Connectivity Neurofeedback Training for Promotion of Working Memory: An fNIRS Study in Healthy Male Participants. IEEE Access 2021; 9: 62316-62331
• 13 van Burken P, de Boer TC, Browne G. Mindfulness en fysiotherapie. Bohn Stafleu van Loghum; 2017
• 14 Siemionow MZ, Gharb BB, Rampazzo A. The Face as a Sensory Organ. In: Siemionow MZ, eds. The Know-How of Face Transplantation. London: Springer London; 2011: 11-23
• 15 Villemure C, Bushnell CM. Cognitive modulation of pain: how do attention and emotion influence pain processing?. Pain 2002; 95: 195-199
• 16 von Piekartz H, Taxer B. Kopf- und Gesichtsschmerzen: Somatosensorische Verzerrungen erkennen und gezielt behandeln. Teil 1 – Hintergrund, Untersuchung und Evidenz. MSK – Muskuloskelettale Physiotherapie 2024; 28: 301-311
• 17 Merten J. Mimik und Emotion – Die Bedeutung der Gesichtsbewegungen. Psychologie in Österreich 2016; 5: 291-299
• 18 Minio-Paluello I, Porciello G, Pascual-Leone A. et al. Face individual identity recognition: a potential endophenotype in autism. Mol Autism 2020; 11: 81
• 19 Riemer M, Trojan J, Beauchamp M. et al. The rubber hand universe: On the impact of methodological differences in the rubber hand illusion. Neurosci Biobehav Rev 2019; 104: 268-280
• 20 Essick GK, Phillips C, Turvey TA. et al. Facial Altered Sensation and Sensory Impairment After Orthognathic Surgery. Int J Oral Maxillofac Surg 2007; 36: 577-582
• 21 Moseley LG, Wiech K. The effect of tactile discrimination training is enhanced when patients watch the reflected image of their unaffected limb during training. Pain 2009; 144: 314-319
• 22 Essick GK, Franzen O, Whitsel BL. Discrimination and Scaling of Velocity of Stimulus Motion across the Skin. Somatosensory & Motor Research 1988; 6: 21-40
• 23 Ehrenbrusthoff K, Ryan CG, Grüneberg C. et al. A systematic review and meta-analysis of the reliability and validity of sensorimotor measurement instruments in people with chronic low back pain. Musculoskeletal Science and Practice 2018; 35: 73-83
• 24 Catley MJ, O’Connell NE, Berryman C. et al. Is tactile acuity altered in people with chronic pain? a systematic review and meta-analysis. J Pain 2014; 15: 985-1000
• 25 Catley MJ, Tabor A, Wand BM. et al. Assessing tactile acuity in rheumatology and musculoskeletal medicine – how reliable are two-point discrimination tests at the neck, hand, back and foot?. Rheumatology (Oxford) 2013; 52: 1454-1461
• 26 Gülbetekin E, Altun E, Er MN. et al. Effects of right or left face stimulation on self and other perception in enfacement illusion. Social Neuroscience 2021; 16: 189-205
• 27 Wittkopf PG, Lloyd DM, Johnson MI. The effect of visual feedback of body parts on pain perception: A systematic review of clinical and experimental studies. European Journal of Pain 2018; 22: 647-662
• 28 La Touche R, Herranz-Gómez A, Destenay L. et al. Effect of brain training through visual mirror feedback, action observation and motor imagery on orofacial sensorimotor variables: A single-blind randomized controlled trial. Journal of Oral Rehabilitation 2020; 47: 620-635
• 29 Schumann NP, Bongers K, Scholle HC. et al. Atlas of voluntary facial muscle activation: Visualization of surface electromyographic activities of facial muscles during mimic exercises. PLOS ONE 2021; 16: e0254932
• 30 Kerry R, Cagnie B. eds. The Head and Neck: Theory and Practice. Jessica Kingsley Publishers; 2025
• 31 Yamashita S, Hatch JP, Rugh JD. Does chewing performance depend upon a specific masticatory pattern?. Journal of Oral Rehabilitation 1999; 26: 547-553
• 32 Kawai N, Shibata M, Watanabe M. et al. Effects of functional training after orthognathic surgery on masticatory function in patients with mandibular prognathism. Journal of Dental Sciences 2020; 15: 419-425
• 33 von Piekartz H, Stotz E, Both A. et al. Psychometric evaluation of a motor control test battery of the craniofacial region. J Oral Rehabil 2017; 44: 964-973
• 34 Moseley GL, Butler DS, Beames T. eds. The graded motor imagery handbook. Adelaide: Noigroup Publ; 2012
• 35 Hardwick RM, Caspers S, Eickhoff SB. et al. Neural correlates of action: Comparing meta-analyses of imagery, observation, and execution. Neurosci Biobehav Rev 2018; 94: 31-44
• 36 Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci 2004; 27: 169-192
• 37 Kiverstein J, Kirchhoff MD, Thacker M. An Embodied Predictive Processing Theory of Pain Experience. RevPhilPsych 2022; 13: 973-998
• 38 Thacker MA, Moseley GL. First-person neuroscience and the understanding of pain. Medical Journal of Australia 2012; 196: 410-411
• 39 Thacker M. Louis Gifford – revolutionary: the Mature Organism Model, an embodied cognitive perspective of pain. In Touch 2015; 152: 4-9