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Entstehung der Schmerzchronifizierung

  • Chapter
Rückenschmerzen und Nackenschmerzen

Zusammenfassung

Die Empfindlichkeit des nozizeptiven Systems ist nach einer Gewebeschädigung durch periphere und zentrale Sensibilisierung gesteigert. Hieraus resultieren Hyperalgesie und Allodynie, normalerweise eine relativ kurz dauernde Modulation des nozizeptiven Systems, die in eine lang dauernde Modifikation mit veränderter Genexpression übergehen kann. Die molekularen Mechanismen der so entstehenden Schmerzchronifizierung sind klinisch bisher nicht messbar. In der praktischen Schmerztherapie sollte man als Arbeitshypothese davon ausgehen, dass die Chronifizierung ein reversibler Prozess ist. Behandlungsansätze können sich ex iuvantibus aus der diagnostischen Lokalanästhesie und aus pharmakologischen oder verhaltensmedizinischen Eingriffen in Gedächtnisprozesse ergeben. Das implizite assoziative Gedächtnis, das in Form von klassischer oder operanter Konditionierung an der Chronifizierung von Schmerz beteiligt ist, wird umgekehrt auch zur Behandlung chronischer Schmerzen eingesetzt. Die Verhinderung der Konsolidierung des Schmerzgedächtnisses sowie seine Extinktion sind zentrale Ziele einer rationalen Schmerztherapie.

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Literatur

  1. Abraham WC (2003) How long will long-term potentiation last? Philos Trans R Soc London Ser B 358:735–744

    Article  Google Scholar 

  2. Adriaensen H, Gybels J, Handwerker HO, van Hees J (1984) Suppression of C-fibre discharges upon repeated heat stimulation may explain characteristics of concomitant pain sensations. Brain Res 302:203–211

    Article  CAS  PubMed  Google Scholar 

  3. Azad SC, Zieglgänsberger W (2003) Was wissen wir über die Chronifizierung von Schmerz? Schmerz 17:441–444

    Article  CAS  PubMed  Google Scholar 

  4. Birbaumer N, Lutzenberger W, Montoya P, Larbig W, Unertl K, Töpfner S, Grodd W, Taub E, Flor H (1997) Effects of regional anesthesia on phantom limb pain are mirrored in changes in cortical reorganization. J Neurosci 17:5503–5508

    CAS  PubMed  Google Scholar 

  5. Buschmann T, Martinvillalba A, Kocsis JD, Waxman SG, Zimmermann M, Herdegen T (1998) Expression of Jun, Fos and ATF-2 proteins in axotomized explanted and cultured adult rat dorsal root ganglia. Neuroscience 84:163–176

    Article  CAS  PubMed  Google Scholar 

  6. Calford MB, Tweedale R (1991) C-fibres provide a source of masking inhibition to primary somatosensory cortex. Proc R Soc London Ser B 243:269–275

    Google Scholar 

  7. Cervero F, Laird JMA (1991) One pain or many pains? A new look at pain mechanisms. News Physiol Sci 6:268–273

    Google Scholar 

  8. Elbert T, Pantev C, Wienbruch C, Rockstroh B, Taub E (1995) Increased cortical representation of the fingers of the left hand in string players. Science 270:305–307

    Article  CAS  PubMed  Google Scholar 

  9. Erskine A, Morley S, Pearce S (1990) Memory for pain: a review. Pain 41:255–265

    Article  CAS  PubMed  Google Scholar 

  10. Feine JS, Lavigne GJ, Thuan Dao TT, Morin C, Lund JP (1998) Memories of chronic pain and perceptions of relief. Pain 77: 137–141

    Article  CAS  PubMed  Google Scholar 

  11. Fischer TZ, Waxman SG (2010) Familial pain syndromes from mutations of the NaV1.7 sodium channel. Ann NY Acad Sci 1184:196–207

    Article  CAS  PubMed  Google Scholar 

  12. Flor H (2000) The functional organization of the brain in chronic pain. In: Sandkühler J, Bromm B, Gebhart GF (Hrsg) Nervous system plasticity and chronic pain, progress in brain research. Elsevier, Amsterdam, S 313–322

    Chapter  Google Scholar 

  13. Flor H, Fydrich T, Turk DC (1992) Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain 49:221–230

    Article  CAS  PubMed  Google Scholar 

  14. Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, Larbig W, Taub E (1995) Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482–484

    Article  CAS  PubMed  Google Scholar 

  15. Flor H, Braun C, Elbert T, Birbaumer N (1997) Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett 224:5–8

    Article  CAS  PubMed  Google Scholar 

  16. Fordyce WE, Roberts AH, Sternbach RA (1985) The behavioral management of chronic pain: a response to critics. Pain 22: 113–125

    Article  CAS  PubMed  Google Scholar 

  17. Gallar J, Pozo MA, Rebollo I, Belmonte C (1990) Effects of capsaicin on corneal wound healing. Invest Ophthalmol Vis Sci 31:1968–1974

    CAS  PubMed  Google Scholar 

  18. Gillette R, Huang RC, Hatcher N, Moroz LL (2000) Cost-benefit analysis potential in feeding behavior of a predatory snail by integration of hunger, taste, and pain. Proc Natl Acad Sci USA 97:3585–3590

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gracely RH, Lynch SA, Bennett GJ (1992) Painful neuropathy: altered central processing, maintained dynamically by peripheral input. Pain 51:175–194

    Article  CAS  PubMed  Google Scholar 

  20. Jensen MP, Romano JM, Turner JA, Good AB, Wald LH (1999) Patient beliefs predict patient functioning: further support for a cognitive-behavioural model of chronic pain. Pain 81: 95–104

    Article  CAS  PubMed  Google Scholar 

  21. Ji RR, Woolf CJ (2001) Neuronal plasticity and signal transduction in nociceptive neurons: Implications for the initiation and maintenance of pathological pain. Neurobiol Disease 8:1–10

    Google Scholar 

  22. Kandel ER, Schwartz JH, Jessell TM (2000) Principles of neural science, 4. Aufl., Kap. 62: Learning and memory. McGraw-Hill, New York, S 1225–1246

    Google Scholar 

  23. Kim HS, Neubert JK, Miguel AS, Xu K, Krishnaraju RK, Iadarola MJ, Goldman D, Dionne RA (2004) Genetic influence on variability in human acute experimental pain sensitivity associated with gender, ethnicity and psychological temperament. Pain 109:488–496

    Article  PubMed  Google Scholar 

  24. Klein T, Magerl W, Hopf HC, Sandkühler J, Treede RD (2004) Perceptual correlates of nociceptive long-term potentiation and long-term depression in humans. J Neurosci 24:964–971

    Article  CAS  PubMed  Google Scholar 

  25. Knecht S, Henningsen H, Elbert T, Flor H, Höhling C, Pantev C, Taub E (1996) Reorganizational and perceptional changes after amputation. Brain 119:1213–1219

    Article  PubMed  Google Scholar 

  26. Koltzenburg M, Torebjörk HE, Wahren LK (1994) Nociceptor modulated central sensitization causes mechanical hyperalgesia in acute chemogenic and chronic neuropathic pain. Brain 117: 579–591

    Article  PubMed  Google Scholar 

  27. LaMotte RH, Shain CN, Simone DA, Tsai E-FP (1991) Neurogenic hyperalgesia: psychophysical studies of underlying mechanisms. J Neurophysiol 66:190–211

    CAS  PubMed  Google Scholar 

  28. Lenz FA, Garonzik IM, Zirh TA, Dougherty PM (1998) Neuronal activity in the region of the thalamic principal sensory nucleus (ventralis caudalis) in patients with pain following amputations. Neuroscience 86:1065–1081

    Article  CAS  PubMed  Google Scholar 

  29. Magerl W, Fuchs PN, Meyer RA, Treede RD (2001) Roles of capsaicin-insensitive nociceptors in pain and secondary hyperalgesia. Brain 124:1754–1764

    Article  CAS  PubMed  Google Scholar 

  30. Marsicano G, Wotjak CT, Azad SC, Bisogno T, Rammes G, Cascio MG, Hermann H, Tang J, Hofmann C, Zieglgänsberger W, Di Marzo V, Lutz B (2002) The endogenous cannabinoid system controls extinction of aversive memories. Nature 418:530–534

    Article  CAS  PubMed  Google Scholar 

  31. Merskey H, Bogduk N (1994) Classification of chronic pain, 2. Aufl. IASP Press, Seattle, S 1

    Google Scholar 

  32. Milinkeviciute G, Gentile C, Neely GG (2012) Drosophila as a tool for studying the conserved genetics of pain. Clin Genet 82: 359–366

    Article  CAS  PubMed  Google Scholar 

  33. Nagasako EM, Oaklander AL, Dworkin RH (2003) Congenital insensitivity to pain: an update. Pain 101:213–219

    Article  PubMed  Google Scholar 

  34. Ørstavik K, Weidner C, Schmidt R, Schmelz M, Hilliges M, Jørum E, Handwerker H, Torebjörk E (2003) Pathological C-fibres in patients with a chronic painful condition. Brain 126:567–578

    Article  PubMed  Google Scholar 

  35. Pfau DB, Klein T, Putzer D, Pogatzki-Zahn EM, Treede RD, Magerl W (2011) Analysis of hyperalgesia time courses in humans after painful electrical high-frequency stimulation identifies a possible transition from early to late LTP-like pain plasticity. Pain 152:1532–1539

    Article  PubMed  Google Scholar 

  36. Pfingsten M (2004) Angstvermeidungs-Überzeugungen bei Rückenschmerzen. Schmerz 18:17–27

    Article  CAS  PubMed  Google Scholar 

  37. Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P (1997) Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 73:77–85

    Article  CAS  PubMed  Google Scholar 

  38. Plappert CF, Pilz PKD, Becker K, Becker CM, Schnitzler HU (2001) Increased sensitization of acoustic startle response in spasmodic mice with a mutation of the glycine receptor alpha1-subunit gene. Behav Brain Res 121:57–67

    Article  CAS  PubMed  Google Scholar 

  39. Prescott SA (1998) Interactions between depression and facilitation within neural networks: updating the dual-process theory of plasticity. Learning Memory 5:446–466

    CAS  Google Scholar 

  40. Quiroga RQ, Luijtelaar ELJM (2002) Habituation and sensitization in rat auditory evoked potentials: a single-trial analysis with wavelet denoising. Int J Psychophysiol 43:141–153

    Article  Google Scholar 

  41. Raspe H, Hüppe A, Matthis C (2003) Theorien und Modelle der Chronifizierung: auf dem Weg zu einer erweiterten Definition chronischer Rückenschmerzen. Schmerz 17:359–366

    Article  CAS  PubMed  Google Scholar 

  42. Roayaie K, Crump JG, Sagasti A, Bargmann CI (1998) The G alpha protein ODR–3 mediates olfactory and nociceptive function and controls cilium morphogenesis in C. elegans olfactory neurons. Neuron 20:55–67

    Article  CAS  PubMed  Google Scholar 

  43. Sandkühler J (2000) Learning and memory in pain pathways. Pain 88:113–118

    Article  PubMed  Google Scholar 

  44. Sandkühler J (2009) Models and mechanisms of hyperalgesia and allodynia. Physiol Rev 89:707–58

    Article  PubMed  Google Scholar 

  45. Schafe GE, Nader K, Blair HT, LeDoux JE (2001) Memory consolidation of Pavlovian fear conditioning: a cellular and molecular perspective. TINS 24:540–546

    Google Scholar 

  46. Schaible HG, Del Rosso A, Matucci-Cerinic M (2005) Neurogenic aspects of inflammation. Rheum Dis Clin North Am 31:77–101

    Article  PubMed  Google Scholar 

  47. Schneider C, Palomba D, Flor H (2004) Pavlovian conditioning of muscular responses in chronic pain patients: central and peripheral correlates. Pain 112:239–247

    Article  PubMed  Google Scholar 

  48. Simone DA, Baumann TK, LaMotte RH (1989) Dose-dependent pain and mechanical hyperalgesia in humans after intradermal injection of capsaicin. Pain 38:99–107

    Article  CAS  PubMed  Google Scholar 

  49. Snider WD, McMahon SB (1998) Tackling pain at the source: New ideas about nociceptors. Neuron 20:629–632

    Article  CAS  PubMed  Google Scholar 

  50. Sukhotinsky I, Ben Dor E, Raber P, Devor M (2004) Key role of the dorsal root ganglion in neuropathic tactile hypersensibility. Eur J Pain 8:135–143

    Article  PubMed  Google Scholar 

  51. Tan AM, Waxman SG (2012) Spinal cord injury, dendritic spine remodeling, and spinal memory mechanisms. Exp Neurol 235:142–151

    Article  PubMed  Google Scholar 

  52. Thomas E, Sandor PS, Ambrosini A, Schoenen J (2002) A neural network model of sensitization of evoked cortical responses in migraine. Cephalalgia 22:48–53

    Article  CAS  PubMed  Google Scholar 

  53. Treede RD (1998) Pathophysiologie und Diagnostik von sensiblen Störungen bei Patienten mit sympathikusabhängigen Schmerzen. Schmerz 12:250–260

    Article  CAS  PubMed  Google Scholar 

  54. Treede RD, Meyer RA, Raja SN, Campbell JN (1992) Peripheral and central mechanisms of cutaneous hyperalgesia. Prog Neurobiol 38:397–421

    Article  CAS  PubMed  Google Scholar 

  55. Treede RD, Handwerker HO, Baumgärtner U, Meyer RA, Magerl W (2004) Hyperalgesia and allodynia: taxonomy, assessment, and mechanisms. In: Brune K, Handwerker HO (Hrsg) Hyperalgesia: molecular mechanisms and clinical implications, Vol 30. IASP Press, Seattle, S 1–15

    Google Scholar 

  56. Treede RD, Klein T, Magerl W (2006) Pain memory and central sensitization in humans. In: Flor H, Kalso E, Dostrovsky JO (Hrsg) Proceedings of the 11th World Congress on Pain. IASP Press, Seattle, S 251–267

    Google Scholar 

  57. Treede RD, Müller-Schwefe G, Thoma R (2010) Kodierung chronischer Schmerzen im ICD-10. Der Schmerz 24:207–208

    Article  PubMed  Google Scholar 

  58. Turk DC, Flor H (1984) Etiological theories and treatments for chronic back pain. II. Psychological models and interventions. Pain 19:209–233

    Article  CAS  PubMed  Google Scholar 

  59. Turner JA, Calsyn DA, Fordyce WE, Ready LB (1982) Drug utilization patterns in chronic pain patients. Pain 12:357–363

    Article  CAS  PubMed  Google Scholar 

  60. Vlaeyen JWS, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332

    Article  CAS  PubMed  Google Scholar 

  61. Von Korff M, Miglioretti DL (2005) A prognostic approach to defining chronic pain. Pain 117:304–313

    Article  Google Scholar 

  62. Waberski TD, Gobbelé R, Kawohl W, Cordes C, Buchner H (2003) Immediate cortical reorganization after local anesthetic block of the thumb: source localization of somatosensory evoked potentials in human subjects. Neurosci Lett 347: 151–154

    Article  CAS  PubMed  Google Scholar 

  63. Waxman SG, Dib-Hajj S, Cummins TR, Black JA (1999) Sodium channels and pain. Proc Natl Acad Sci USA 96:7635–7639

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Weiss T, Miltner WHR, Huonker R, Friedel R, Schmidt I, Taub E (2000) Rapid functional plasticity of the somatosensory cortex after finger amputation. Exp Brain Res 134:199–203

    Article  CAS  PubMed  Google Scholar 

  65. Weng HH, Fitzgerald J (2006) Current issues in joint replacement surgery. Curr Opin Rheumatol 18:163–169

    Article  PubMed  Google Scholar 

  66. Williams DA, Thorn BE (1989) An empirical assessment of pain beliefs. Pain 36:351–358

    Article  CAS  PubMed  Google Scholar 

  67. Wittenburg N, Baumeister R (1999) Thermal avoidance in Caenorhabditis elegans: An approach to the study of nociception. Proc Natl Acad Sci USA 96:10477–10482

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Woolf CJ, Salter MW (2000) Neuronal plasticity: increasing the gain in pain. Science 288:1765–1769

    Article  CAS  PubMed  Google Scholar 

  69. Woolf CJ, Walters ET (1991) Common patterns of plasticity contributing to nociceptive sensitization in mammals and aplysia. TINS 14:74–78

    Google Scholar 

  70. Wurmthaler C, Gerbershagen HU, Dietz G, Korb J, Nilges P, Schillig S (1996) Chronifizierung und psychologische Merkmale — Die Beziehung zwischen Chronifizierungsstadien bei Schmerz und psychophysischem Befinden, Behinderung und familiären Merkmalen. Z Gesundheitspsychol 4:113–136

    Google Scholar 

  71. Zhuang ZY, Gerner P, Woolf CJ, Ji RR (2005) ERK is sequentially activated in neurons, microglia, and astrocytes by spinal nerve ligation and contributes to mechanical allodynia in this neuropathic pain model. Pain 114:149–159

    Article  PubMed  Google Scholar 

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  1. Lehrstuhl für Neurophysiologie, Universität Heidelberg, Med. Fakultät Mannheim, Ludolf-Krehl-Str. 13–17, 68167, Mannheim

    Prof. Dr. R.-D. Treede

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Editors and Affiliations

  1. DRK Schmerz-Zentrum Mainz, Mainz, Deutschland

    Hans-Raimund Casser

  2. Ruhr-Universität Bochum, Bochum, Deutschland

    Monika Hasenbring

  3. Philipps-Universität Marburg, Marburg, Deutschland

    Annette Becker

  4. Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland

    Ralf Baron

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Treede, RD. (2016). Entstehung der Schmerzchronifizierung. In: Casser, HR., Hasenbring, M., Becker, A., Baron, R. (eds) Rückenschmerzen und Nackenschmerzen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29775-5_3

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  • DOI: https://doi.org/10.1007/978-3-642-29775-5_3

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