Nervenheilkunde 2004; 23(05): 279-296
DOI: 10.1055/s-0038-1626376
Original- und Übersichtsarbeiten - Original and Review Articles
Schattauer GmbH

Behandlung neuropathischer Schmerzen

Angriffspunkte und Wirkmechanismen von ArzneistoffenMode of action of drugs for treating neuropathic pain disorders
A. Ziegler
1   Institut für Pharmakologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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31. Januar 2018 (online)


Die Konzepte zur Entstehung und Aufrechterhaltung neuropathischer Schmerzzustände ermöglichen es, die potenziell relevanten Eigenschaften und Wirkmechanismen der Arzneistoffe zu definieren, die zur Behandlung der unterschiedlichen Formen des neuropathischen Schmerzes eingesetzt werden. Sie machen darüber hinaus verständlich, warum die zur Behandlung von Nozizeptorschmerzen eingesetzten Pharmaka sich bei Formen des neuropathischen Schmerzes als weniger wirksam erweisen. Auch werden Strategien erkennbar, wie diese Ineffektivität überkommen und einer Tachyphylaxie des gewünschten analgetischen Effektes begegnet werden kann. Es zeichnet sich als durchgängiges Prinzip ab, dass sich hoch selektiv wirkende Pharmaka in der Therapie nicht bewähren, sondern gleichermaßen wirksame und verträgliche Arzneimittel durch bestimmte Muster unterschiedlicher pharmakologischer Effekte gekennzeichnet sind.


Major progress in research on the etiology and pathophysiology of neuropathic pain allows to define targets and mechanisms of action of those drugs used to treat the different forms of neuropathic pain. The concepts explain why drugs known to cause analgesia in nociceptor pain are less active in neuropathic pain. Strategies can be developed to change these less effective to active drugs und to avoid the development of tachyphylaxis. The efforts to develop highly selective and most specific drugs for treating neuropathic pain were successfull, the highly specific acting drugs are, however, consistently causing intolerable side effects. A pattern of different pharmacological activities seems to be required for equally effective and tolerable remedies.

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