Vom Schmerz zur somatoformen Ausweitung

Zusammenfassung

Aufgrund der neuronalen Verbindungen der nozizeptiven Impulsübertragung werden bestimmte Hirnstrukturen aktiviert. Davon ausgehend kann es zu Störungen kommen, die Funktionen betreffen, die von diesen Hirnarealen reguliert werden. In erster Linie können Schlafstörungen auftreten und Störungen der Hypothalamus-Hypophysen-Nebennieren-Achse. Infolge dieser Störungen bzw. einer negativen gegenseitigen Beeinflussung kann es zu umfassenden Störungen der physischen, psychischen und kognitiven Funk-tionen kommen. Diese Störungen können einen wesentlichen Einfluss auf die kognitive (gedankliche, imaginierte, mit eigenen Überzeugungen übereinstimmende) und schließlich emotionale Verarbeitung haben. Daraus ergeben sich Probleme in der Bewältigung, zumal wenn aufgrund der Veranlagung oder der aktuellen Lebensbedingungen eine Neigung zu negativen Kognitionen und Emotionen und zur Katastrophisierung besteht. Es handelt sich um eine prozesshafte Entwicklung, die durch Ergebnisse der empirischen Studien belegt wird und in vieler Hinsicht Symptomverstärkung und -ausweitung erklären kann. Ausgehend davon muss in der Behandlung der chronischen Schmerzen der Fokus weg vom nozizeptiven Impuls hin zu einer umfassenden therapeutischen Beeinflussung der be-einträchtigten Funktionen verlegt werden. Dabei ist eine angemessene Information des Patienten bezüglich der komplexen Zusammenhänge beim chronischen Schmerz eine wichtige Voraussetzung.

Summary

Based on the neuronal connections of the nociceptive impulse transfer, specific brain structures (reticular formation, hypothalamus) are activated. Based on this, disturbances related to functions can occur which are regulated from these areas of the brain. Primarily sleep disturbances and disturbances of the hypothalamus-hypophyseal-suprarenal axis can occur. Due to these disturbances and/or a vice versa influence, comprehensive disturbances of the physical, psychological and cognitive functions can arise. These disturbances can have a substantial influence on cognitive (mental, imagined, agreeing with own convictions) and finally emotional processing. Thereby problems in coping result, particularly if due to a disposition, or current life events, a tendency to negative cognitions, emotions and catastrophising exists. This development, based on empirical studies, allows, among other things, for an understanding of the increase and development of symptoms. From this, the treatment of chronic pain must include a shift from the focus on the noxious stimuli or nociceptive impulse to a comprehensive therapeutic influencing of the impaired functions. Herewith, appropriate information of the affected person, considering the complex connections in chronic pain, is an important prerequisite.

Schlüsselwörter

Chronischer Schmerz - Schlafstörung - Symptomausweitung

Keywords

Chronic pain - sleep disturbance - symptom augmentation

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