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Neuropathische Schmerzsyndrome und Neuroplastizität in der funktionellen Bildgebung

Neuropathic pain and neuroplasticity in functional imaging studies

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Zusammenfassung

Neuropathische Schmerzsyndrome sind durch das Auftreten von spontanen und Stimulus-induzierten Schmerzen gekennzeichnet. Stimulus-induzierte Schmerzen (Hyperalgesie und Allodynie) können prinzipiell aus Sensibilisierungsprozessen im peripheren (primäre Hyperalgesie) oder zentralen Nervensystem (sekundäre Hyperalgesie) resultieren. Während die zugrunde liegenden pathophysiologischen Vorgänge am Nozizeptor und die relevanten spinalen synaptischen Prozesse mittlerweile besser verstanden werden, sind die zerebralen Areale, die für die Vermittlung von Hyperalgesie und Allodynie relevant sind, noch Gegenstand kontroverser Diskussion. In den letzten Jahren haben sich insbesondere durch den Einsatz von funktionellen bildgebenden Methoden (funktionelle Magnetresonanztomographie, fMRT; Magnetenzephalographie, MEG; Positronenemissionstomographie, PET) neue Einblicke in fehlgeleitete Verarbeitungsprozesse von neuropathischen Schmerzsyndromen ergeben. In dieser Übersicht werden verschiedene Mechanismen erläutert, die zu einer Chronifizierung von Nervenschmerzsyndromen beitragen können. Dazu zählen Reorganisationsphänomene von somatotopen Karten in sensorischen und motorischen Arealen (insbesondere relevant bei Phantomschmerzen und Komplex-regionalen Schmerzsyndromen), Intensitätssteigerungen in primär nozizeptiven Arealen, Rekrutierung von neuen Kortexarealen, die normalerweise nicht durch Schmerzreize aktiviert werden, und fehlerhafte Aktivität von Gehirnarealen, die normalerweise eine endogene Schmerzhemmung bewirken. Daneben weisen PET-Studien auf Veränderungen von exzitatorischen und inhibitorischen Transmittersystemen hin. Weiterentwickelte Methoden der morphologischen Bildgebung (v. a. die Voxel-basierte Morphometrie) zeigen schließlich substanzielle strukturelle Veränderungen, die chronische Schmerzen auch als eine neurodegenerative Erkrankung auffassen lassen.

Abstract

Neuropathic pain syndromes are characterised by the occurrence of spontaneous ongoing and stimulus-induced pain. Stimulus-induced pain (hyperalgesia and allodynia) may result from sensitisation processes in the peripheral (primary hyperalgesia) or central (secondary hyperalgesia) nervous system. The underlying pathophysiological mechanisms at the nociceptor itself and at spinal synapses have become better understood. However, the cerebral processing of hyperalgesia and allodynia is still controversially discussed. In recent years, neuroimaging methods (functional magnetic resonance imaging, fMRI; magnetoencephalography, MEG; positron emission tomography, PET) have provided new insights into the aberrant cerebral processing of neuropathic pain. The present paper reviews different cerebral mechanisms contributing to chronicity processes in neuropathic pain syndromes. These mechanisms include reorganisation of cortical somatotopic maps in sensory or motor areas (highly relevant for phantom limb pain and CRPS), increased activity in primary nociceptive areas, recruitment of new cortical areas usually not activated by nociceptive stimuli and aberrant activity in brain areas normally involved in descending inhibitory pain networks. Moreover, there is evidence from PET studies for changes of excitatory and inhibitory transmitter systems. Finally, advanced methods of structural brain imaging (voxel-based morphometry, VBM) show significant structural changes suggesting that chronic pain syndromes may be associated with neurodegeneration.

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Danksagung

Diese Arbeit wurde unterstützt durch den Deutschen Forschungsverbund „Neuropathischer Schmerz“ (DFNS) des Bundesministeriums für Bildung und Forschung und durch die Deutsche Forschungsgemeinschaft (MA 3345/11-1).

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  1. Neurologische Klinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 , Erlangen, Deutschland

    C. Maihöfner, F.T. Nickel & F. Seifert

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  1. C. Maihöfner
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Maihöfner, C., Nickel, F. & Seifert, F. Neuropathische Schmerzsyndrome und Neuroplastizität in der funktionellen Bildgebung. Schmerz 24, 137–145 (2010). https://doi.org/10.1007/s00482-010-0902-6

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