Das idiopathische Parkinsonsyndrom und Schmerz – diagnostische und therapeutische Ansätze für ein herausforderndes nicht-motorisches Symptom

Zusammenfassung

Schmerzen beim idiopathischen Parkinsonsyndrom (IPS) treten bei 40 %–95 % der Patienten auf und beeinträchtigen die Lebensqualität, sind jedoch oftmals unterdiagnostiziert und werden nur unsystematisch therapiert.

Schmerzätiologie und Schmerzcharakter können sehr vielfältig sein und obwohl die Optimierung der Parkinson-Medikation die Basis der Schmerzbehandlung ist, sind in den meisten Fällen zusätzliche Therapien zur suffizienten Behandlung der Schmerzen notwendig.

In dieser Arbeit werden Epidemiologie und Pathophysiologie des Schmerzes beim IPS dargestellt sowie Schmerzcharakteristika beschrieben. Es wird aufgezeigt, welche Methoden der Schmerzbehandlung beim IPS genutzt werden und wie Patienten die Effektivität der Therapien beurteilen. Auf Basis der begrenzten Datenlage und eines Expertenkonsens wurden praxisrelevante Vorschläge zu Diagnostik und Therapie bei Schmerz und IPS gegeben.

Diese Arbeit soll dazu beitragen, Neurologen für das Thema Schmerz beim IPS zu sensibilisieren. Aufgrund der Komplexität und Besonderheiten der neurodegenerativen Erkrankung sollten Neurologen an der interdisziplinären Schmerztherapie beim IPS beteiligt sein und ihren Patienten differenziertere Therapieoptionen bereitstellen als bisher.

Abstract

Pain affects 40 %–95 % of patients with Parkinson disease (PD) and reduces their quality of life but is often underdiagnosed and treated unsystematically. Pain aetiology and pain characteristics can be very heterogeneous, and although the optimisation of antiparkinsonian medication is essential for pain treatment, in most cases, additional therapies for sufficient treatment of pain are necessary. This paper describes the epidemiology and pathophysiology of pain in PD, delineates pain characteristics, highlights the methods of pain management in PD and how patients assess the effectiveness of the therapies. Based on the limited data available and expert consensus, practice-oriented suggestions for diagnosis and therapy of pain in PD are provided. Neurologists should be sensitised to the topic of pain in PD. Due to the complexity of the neurodegenerative disease itself, neurologists should be involved in the interdisciplinary pain therapy of PD and provide their patients with more sophisticated treatment options than has been done so far.

Schlüsselwörter

Schmerz - Epidemiologie - Pathophysiologie - Therapie - Idiopathisches Parkinsonsyndrom

Key words

pain - epidemiology - pathophysiology - therapy - Parkinson’s disease

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