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Chronifizierung postoperativer Schmerzen

Physiologie, Risikofaktoren und Prävention

Transition from acute to chronic postsurgical pain

Physiology, risk factors and prevention

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Zusammenfassung

Unter chronischen postoperativen Schmerzen (CPSP) versteht man Schmerzen, die mindestens 3 Monate nach einer Operation persistieren. Sie treten mit einer Häufigkeit von etwa 5–60% auf und führen in ungefähr 1–3% der Fälle zu starken schmerzbedingten Beeinträchtigungen. Die Pathomechanismen, die zur Entwicklung von CPSP führen, sind komplex. Eine Nervenläsion mit neuropathischen Schmerzen kann eine Ursache für CPSP sein, jedoch werden bei vielen CPSP-Patienten keine neuropathischen Schmerzen nachgewiesen. Die periphere und zentrale Sensibilisierung sind die wesentlichen Mechanismen, die eine Chronifizierung akuter postoperativer Schmerzen hervorrufen. Da die CPSP-Therapie häufig schwierig ist, wird versucht, die zentrale Sensibilisierung zu verhindern. Neue Erkenntnisse zur Physiologie der CPSP-Entwicklung, perioperativen Risikofaktoren und Möglichkeiten präventiver Interventionen werden diskutiert.

Abstract

Chronic postsurgical pain (CPSP) is defined as pain persisting for longer than 3 months postoperatively. The frequency of occurrence ranges from 5 % to 60 % in all types of surgery and 1-3 % of patients with CPSP will suffer from severe pain and pain-related interference with daily activities. The pathological mechanisms which lead to the development of CPSP are complex and have not yet been analyzed. Neuropathic pain after surgical nerve lesions has been reported. Many patients with CPSP, however, do not present with any neuropathic pain characteristics. Peripheral and central sensitization are the essential mechanisms of the development of pain chronicity in the postoperative period. As treatment of CPSP is demanding it is attempted to prevent central sensitization before CPSP develops. New scientific findings on the development of CPSP, perioperative risk factors and the potential of preventative interventions are discussed.

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  1. Klinik für Anästhesiologie und operative Intensivmedizin, Heidelberglaan 100, 3584 CX, Utrecht, Niederlande

    H.J. Gerbershagen

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Gerbershagen, H. Chronifizierung postoperativer Schmerzen. Schmerz 27, 81–96 (2013). https://doi.org/10.1007/s00482-012-1287-5

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