Interventionelle Schmerzbehandlung nach Rückenmarkschädigungen

Zusammenfassung

Trotz medizinischem Fortschritt, der Rückenmarkverletz-ten relative Gesundheit und Lebenserwartung zurückgibt, ist der chronische Schmerz bei dieser Patientengruppe häufig eine bedeutende Herausforderung. In die-ser Übersichtsarbeit sollen die Behandlungsoptionen zur Schmerztherapie bei Rückenmarkverletzten zusammenfassend dargestellt werden, beginnend mit konservativmedikamentösen und physikalischen Therapieformen bis hin zu chirurgisch-invasiven, einschließlich neuromodulatorischer und neuroablativer Verfahren, auf die hier schwerpunktmäßig eingegegangen werden soll. Üblicherweise ist keine einzelne Behandlung effizient, son-dern ein selektives, individuelles meist kombiniertes Therapieprogramm notwendig.

Summary

Although there has been progress in all medical fields concerning the treatment of patients with spinal cord injury, which offers rather good health status and life expectancy for those, chronic pain is a challenge in this group of patients. In this review all options of pain therapy for spinal cord injured patients are presented in an overview, beginning with conservative medical and physical treatment up to surgical procedures, which include neuromodulatory and neuroablatory procedures, on which is put an emphasis in this article. In common one single treatment alone is not efficient enough, but individually combined and selected therapy programs are necessary for a satisfactory outcome.

Schlüsselwörter

Rückenmarkschädigung - chronischer Schmerz - intrathekale Schmerztherapie - Neuromodulation

Keywords

Spinal cord lesion - chronic pain - intrathecal pain therapy - neuromodulation

• Literatur

• 1 Abs R.. et al Endocrine Consequences of Long-Term Intrathecal Administration of Opioids. J Clin Endocrinol Metab 2000; 85: 2215-22.
• 2 Atkinson JH.. Tricyclic antidepressants in pain management. Pain Manag 1989; 2: 51-4.
• 3 Attal N.. et al Intravenous lidocaine in central pain: a doubleblind placebo controlled psychological study. Neurology 2000; 54: 564-74.
• 4 Bendok B., Levy RM.. Brain stimulation for persistent pain managemen. In Gildenberg PL., Tasker RR.. Eds Textbook of stereotactic and functional neurosurgery. New York: McGraw-Hill; 1998: 1539-46.
• 5 Bier A.. Versuche über die Kokainisierung des Rückenmarks. Dtsch. Z. Chir 1899; 51: 361.
• 6 Buettner UW.. Neuropathische Schmerzen. Dolor 1998; 98 (01) 1-3.
• 7 Cioni B., Meglio M., Pentimmalli L.. et al Spinal cord stimulation in the treatment of paraplegic pain. J Neurosurg 1995; 82: 35-9.
• 8 Crue BL.. Central versus peripheral philosophies of pain. Pain Manag 1988; 1: 218-22.
• 9 Feinmann C.. Pain relief by antidepressants: possible models of action. Pain 1985; 23: 1-8.
• 10 Feuerstein TJ.. Antidepressiva zur Therapie chronischer Schmerzen. Metaanalyse. Der Schmerz 1997; 11: 213-26.
• 11 Fibson JC., White LE.. Denervation hyperpathia: A convulsive syndrome of the spinal cord responsive to carbamazepin therapy. J Neurosurg 1971; 35: 287-90.
• 12 Gonzales RG.. Central pain: Diagnosis and treatment strategies. Neurology 1995; 45: S11-6.
• 13 Hassenbusch S.. et al Management of Intrathe-cal Catheter-Tip Inflammatory Masses: A Consensus Statement. Pain Med 2002; 3: 313-23.
• 14 Kumar K., Nath R., Wyant GM.. Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. J Neurosurg 1991; 75: 402-7.
• 15 Lazorthes Y., Siegfried J., Verdie JC.. et al La stimulation médullaire chronique dans le traitement des douleurs neurogènes. Neurochirurgie 1995; 41: 73-88.
• 16 Loeser JE., Ward AA.. Some effects of deafferentiation of neurons of the cat spinal cord. Arch Neurol 1967; 17: 629-36.
• 17 Melzack R., Wall PD.. Pain Mechanisms: A new theory. A gate control system modulates sensory input from the skin before it evokes pain perception and response. Science 1965; 150: 971-9.
• 18 Melzack R.. The tragedy of needless pain. Science 1990; 362: 27-88.
• 19 Nashold Jr BS , El Naggar AO.. Dorsal root entry zone (DREZ) lesionin. In Rengachary SS., Wilkins RH.. eds Neurosurgical Operative Atlas, vol. 2. Baltimore: Williams and Wilkins; 1992: 9-24.
• 20 North RB., Kidd DH., Zahurak M.. et al Spinal cord stimulation for chronic intractable pain: Experience over two decades. Neurosurgery 1993; 32: 384-95.
• 21 Rariaso AJ.. Chronic pain and spinal cord injury. Clin J Pain 1992; 2: 87-92.
• 22 Rognarsson KT.. Management of Pain in Persons with Spinal Cord Injury. J Spinal Cord Reh 1997; 2: 186-99.
• 23 Sang CN.. NMDA-receptor antagonist in neuropathic pain: experimental methods to clinical trials. Pain Symptom Manage 2000; 19: 21-5.
• 24 Siddall PJ.. et al Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury. Pain 1999; 81: 187-97.
• 25 Stormer S.. et al Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multi-center study. Spinal cord 1997; 35: 446-55.
• 26 Turks ET.. Pain in Spinal Cor. In Block RF., Bosbaum M.. Eds Management of Spinal Cord Injuries. Baltimore: Williams and Wilkins; 1986: 180-211.
• 27 Yaksh TL.. et al Inflammatory Masses Associated with Intrathecal Drug Infusion: A Review of Preclinical Evidence and Human Data. Pain Med 2002; 3: 300-12.
• 28 Young RF., Kroening R., Fulton W.. et al Electrical stimulation of the brain in treatment of chronic pain. J Neurosurg 1985; 62: 389-96.
• 29 Young RF., Rinaldi PC.. Brain stimulatio. In North RB., Levy RM.. eds Neurosurgical management of pain. New York: Springer; 1997: 283-301.