Die neuropathische Komponente beim chronischen Rückenschmerz

Zusammenfassung

Das aktuelle Konzept für chronische Rückenschmerzen postuliert ein Nebeneinander von nozizeptiven und neuropathischen Schmerzkomponenten (Mixed-Pain-Konzept). Die charakteristischen neuropathischen Symptome mit negativen und positiven Phänomenen helfen bei der Diagnosestellung. Durch weitgehend objektive Verfahren wie Bedside-Tests und Fragebögen kann die neuropathische Komponente valide identifiziert werden. Für die therapeutischen Optionen stehen nur Daten für den nozizeptiven Rückenschmerz zur Verfügung. In Anlehnung an klassische neuropathische Schmerzsyndrome versucht man einen Ansatz mit Medikamenten, ohne dass eine spezifische evidenzbasierte Therapie empfohlen werden kann.

Summary

The current model of chronic low back pain postulates the coexistence of nociceptive and neuropathic pain components (mixed-pain-concept). The characteristic neuropathic symptoms with negative and positive phenomena help in the process of identifying the diagnosis. Objective methods such as bedside test and questionnaires help to identify the neuropathic component. With respect to treatment, only data for nociceptive back pain exist. Due to a lack of evidence-based therapies for neuropathic back pain the most promising approach is application of drugs in analogy to classic neuropathic pain syndromes.

Schlüsselwörter

Chronischer Rückenschmerz - neuropathischer Schmerz - Diagnostik - Therapie

Keywords

Chronic low back pain - neuropathic pain - assessment - therapy

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