Management neuropathischer Schmerzen: Ein erfahrungs- und evidenzbasierter Behandlungsalgorithmus.

Pain appears to be a leading symptom of many diseases. Patients suffering from chronic pain are of high risk to develop comorbidities coming along with profound personal- and social disadvantages. Knowledge and awareness about pathomechanisms leading to chronic pain, the individual and social consequences of neuropathic pain as result of chronification as well as its high prevalence of therapy resistance are still not common amoung medical professionals. In daily practice patients are either subject to medical neglect in years of suffering or over-diagnosed and -treated. Pathophysiologically every pain condition depending on duration und intensity and independent from origin will provoke ongoing structural and functional changes in pain-conducting, -processing and -controlling parts of the nervous system. The resulting pain syndromes, which acquire neuropathic features along the chronification process, exhibit increasing resistance to conventional therapies. To recognize neuropathic pain components, in order to initiate correct diagnostics appears to be the first challenge. The second challenge includes the timely initiation of the correct therapy, in order to prevent further chronification. Only a third of the patients suffering from chronic neuropathic pain can be treated sufficiently using conservative strategies as medicated therapy, psycho-, physio- or occupational therapy in the long run. Different interventional treatment strategies have proven to be effective on short-, middle- or long-term outcome. Modern, minimally invasive methods of neuromodulation as spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG) represent additional and effective options for pain management regarding individual improvement of pain and quality of life as well as the entailing costs. [ABSTRACT FROM AUTHOR]