PATHOGENETISCHE KONZEPTE DER SCHMERZENTSTEHUNG

Many neurological diseases are associated with the symptoms of pain. Adequate analgetic therapeutic strategies require precise concepts on distinct pathogenetic mechanisms of pain generation. Recent knowledge on pathophysiological aspects of acute pain development comes predominantly from molecular biological approaches, in particular from the study of altered receptor physiology and pharmacology. The didactic separation of different categories of pain which is orienting itself on a structural anatomic correlate of a specific independent nociceptive system, has not to be given up. It can be used as the main connecting topodiagnostic guide for the diagnostic assignment of acute pain. Pain and categories of different pain states are due to lesions at different levels of the specific nociceptive system: a) the nocisensor system, b) the pain conducting peripheral and central pathways, c) the primary pain controlling structures of the central nervous system at the spinal and brainstem level, d) cortical and subcortical pain evaluating systems, e) efferent pain controlling mechanisms, and f) in a complex interaction of levels a) to e). These aspects together with some recent findings on nocisensor, neuropathic and spinal mechanism of pain generation and modulation will be briefly discussed.