Pathophysiologische Aspekte des Komplexen Regionalen Schmerzsyndroms (CRPS)

Zusammenfassung

Das Komplexe Regionale Schmerzsyndrom (CRPS) zeigt sich durch Einschränkungen in Sensorik und Motorik. Das am stärksten hervorstechende Symptom sind die neuropathischen Schmerzen. Veränderungen sowohl des peripheren Nervensystems als auch spinal und supraspinal sind in der Pathophysiologie des CRPS von Bedeutung. Peripher sind die pathologischen Veränderungen, die bei der Entstehung und Aufrechterhaltung des CRPS eine Rolle spielen, zum einen Entzündungsprozesse, die zu einer peripheren Sensibilisierung führen, zum anderen Veränderungen der Aktivität von Katecholaminen, die einen Einfluss auf das sympathische Nervensystem haben. Weiterhin kommt es zu Veränderungen in der Innervierung, die sich in einer Reduktion von kleinen Nervenfasern widerspiegelt. Auch im Hinterhorn des Rückenmarks finden Sensibilisierungsprozesse statt. Im Laufe der Erkrankung kommt es zu kortikaler Reorganisation in der Hemisphäre kontralateral zur betroffenen Extremität. Diese Veränderungen werden als maladaptive Reorganisationsprozesse angesehen, die an der Schmerzsymptomatik, an Wahrnehmungsveränderungen und Körperschemastörungen maßgeblich beteiligt sind. Außerdem wurden genetische und psychologische Faktoren als Modulatoren der Erkrankung beschrieben. Diese Befunde zeigen, dass das CPRS eine komplexe Erkrankung ist, die pathophysiologisch ein Zusammenspiel verschiedener Faktoren determiniert und nicht durch einzelne pathophysiologische Vorgänge erklärt werden kann.

Abstract

The Complex Regional Pain Syndrome (CRPS) appears to be due to constraints in the sensory and motor systems. The most prominent symptom is the neuropathic pain. There are alterations in the periphery, as well as spinal and supraspinal parts of the nervous system, which are relevant in the pathophysiology of CRPS. In the periphery, the pathological alterations which play a role in the development and maintenance are, on the one hand, inflammatory processes which lead to a peripheral sensitisation and, on the other hand, modifications in the metabolism and in the release of catecholamine which, in turn, affects the sympathetic nervous system. Furthermore, there are changes in the innervations which are reflected in a reduction of small fibres. Sensitisation processes also occur in the dorsal horn of the spinal cord. In the course of this disease, cortical reorganisation occurs in the contralateral hemisphere of the affected extremity. These changes are seen as maladaptive reorganisation processes, which manifest themselves as pain symptoms, perceived sensations and body scheme disorders. Furthermore, there are genetic and psychological factors which are described as modulators of the disease. These findings once again show that CRPS is a complex disorder where many different factors interact and which may not be explained by single pathophysiological events.

Schlüsselwörter

CRPS - Pathophysiologie - Schmerz - kortikale Plastizität

Key words

CRPS - pathophysiology - pain - cortical plasticity

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