Therapie neuropathischer schmerzen: Mechanismen basiert oder leitlinien gesteuert?

Neuropathic pain arises as a consequence of a lesion or a disease of the somatosensory system at a peripheral or central level. So far neuropathic pain has been classified according to the cause of the nerve lesion. Due to inadequate treatment results and to the multidimensional character of neuropathic pain, the new insight could be established to treat every single clinical sign and symptom according to a mechanism-based therapy. Thus the analysis of the somatosensory symptoms as tracer for the underlying pathophysiological mechanisms is of great relevance. The appropriate diagnosis, e. g. quantitative sensory testing (QST), could already be established in guidelines. The possibility of a future mechanism-based drug therapy has still to be verified in large-scale comparative pharmacological and non-pharmacological studies. The present treatment as per guidelines is based on various systemic drugs with different modes of action and topical supplements.