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Erhöhte Schmerzempfindlichkeit unter Dauerbehandlung mit Opiaten

Increased sensitivity to pain in long-term opioid treatment

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Zusammenfassung

Die Verordnung von Opiatanalgetika hat in den vergangenen Jahren zur Behandlung chronischer und teilweise subschwelliger Schmerzen zunehmende Verbreitung gefunden. Umfangreiche tier- und humanexperimentelle Befunde und klinische Beobachtungen zeigen jedoch, dass eine andauernde Opiatmedikation nicht nur zu einer Toleranzentwicklung hinsichtlich der analgetischen Effekte führt, sondern im Gegenteil sogar zu einer erhöhten Schmerzsensitivität im Vergleich zu einer Plazebogabe. Opioide können nicht zur Dauerbehandlung bei chronischen Schmerzen empfohlen werden, sondern sind kontraindiziert.

Das Absetzen einer andauernden Opiatmedikation gestaltet sich häufig schwierig. Wichtige Therapieschritte sind hierbei eine sorgfältige Patientenedukation, Empathie und unkonditionales Akzeptieren des Patienten, Motivierung und supportive Unterstützung, Koordinierung mit anderen Behandlern, Entgiftung, Förderung der Schmerztoleranz, Förderung eines gesundheitsförderlichen Verhaltens und Salutotherapie, Ausschöpfung der Therapiealternativen bezüglich der Grunderkrankung und partizipationsorientierte alternative Analgetikamedikation.

Summary

Recent years have seen a rise in the prescription of strong opioids for chronic and even subthreshold forms of pain. Animal and human experiments and clinical observations have shown that, compared to placebos, chronic opioid administration results in not only tolerance to its analgesic effects but also in heightened pain sensitivity. Therefore chronic, especially high-dose, opioid treatment can not be recommended for chronic pain but is instead contraindicated. Patients on long-term opioids will often reject proposals to withdraw the drug. Important elements of treatment are patient education, empathy and unconditional acceptance by the patient, motivation enhancement and psychological support, collaboration with other prescribers and therapists, detoxification, measures to increase pain tolerance, encouragement of general health behavior and salutotherapy, treatment of the primary illness, and prescription of participation oriented alternative analgesics.

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Authors and Affiliations

  1. Dept. of Psychiatry, University of Hawaii, Honolulu, USA

    J. Streltzer

  2. Forschungsgruppe Psychosomatische Rehabilitation, Charité – Universitätsmedizin Berlin und Rehabilitationszentrum Seehof, Teltow, Lichterfelder Allee 55, 14513, Berlin, Deutschland

    M. Linden

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Streltzer, J., Linden, M. Erhöhte Schmerzempfindlichkeit unter Dauerbehandlung mit Opiaten. Nervenarzt 79, 607–611 (2008). https://doi.org/10.1007/s00115-008-2454-x

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