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Diagnose und Therapie von tumorbedingten Schmerzen

Diagnosis and therapy of tumor related pain

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Zusammenfassung

Die von der WHO 1986 erstmals formulierten WHO-Leitlinien zur Tumorschmerztherapie sind im Grundsatz nach wie vor gültig. Eine effiziente Behandlung setzt eine exakte Schmerzanamnese und -diagnose voraus. In Absprache mit dem Patienten wird ein inhaltlich und zeitlich gestaffeltes multimodales Therapiekonzept erstellt. Bezüglich der medikamentösen Therapie gilt, dass bei insuffizienter Schmerzlinderung durch Nicht-Opioidanalgetika schwache Opioide zusätzlich gegeben werden. Bei Schmerzpersistenz werden diese durch starke Opioide ersetzt. Die Verfügbarkeit neuer Substanzen und/oder innovativer galenischer Zubereitungen erlaubt individuell angepasste Therapieformen unter Berücksichtigung metabolischer und schmerzsyndromspezifischer Gegebenheiten. Eine weitere Option stellen Koanalgetika dar, die in Abhängigkeit von Schmerztyp zumeist in Ergänzung der Analgetika gegeben werden.

Abstract

The World Health Organization guidelines for cancer pain therapy from 1986 are still valid. A prerequisite for adequate pain palliation is an exact anamnesis and pain diagnosis. A multimodal, staged therapeutic concept then needs to be formulated according to the requirements of the patient. The pharmacological treatment starts with non-opioids. If pain control remains insufficient, weak opioids are added. In case of persistent pain these are replaced by strong opioids. The availability of new opioids and/or preparations admits a more sophisticated approach to metabolic disorders and specific pain syndromes. Depending on the presenting pain type, co-analgesics might be added.

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  1. Zentrum für Palliativmedizin, Kliniken Essen-Mitte, 45136, Henricistraße 92, Essen, Deutschland

    M. Kloke

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  1. M. Kloke
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Correspondence to M. Kloke.

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Kloke, M. Diagnose und Therapie von tumorbedingten Schmerzen. Urologe 46, 7–13 (2007). https://doi.org/10.1007/s00120-006-1277-2

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