Skip to main content
SpringerLink
Log in

Adenosin zur Behandlung von Ischämieschmerzen bei Thrombangiitis obliterans

Ein Fallbericht

Adenosin for treatment of ischemic pain in thromboangiitis obliterans

A case report

  • Fallberichte
  • Published:
Der Schmerz Aims and scope Submit manuscript

Zusammenfassung

Die Schmerztherapie bei Ischämieschmerzen ist häufig unbefriedigend. Aktuelle Befunde zeigen, dass Patienten mit chronischer Ischämie eine sensorische Neuropathie mit Zeichen einer zentralen Sensibilisierung entwickeln können. Dies macht eine Therapie mit konventionellen Analgetika und Medikamenten gegen neuropathischen Schmerz möglich. Auch Adenosin besitzt eine schmerzlindernde Wirkung bei neuropathischem Schmerz und könnte damit eine Therapieoption bei Ischämieschmerzen darstellen.

Wir berichten über einen Patienten mit Thrombangiitis obliterans, dem wir neben einer umfassenden medikamentösen Schmerztherapie zusätzlich Adenosin intravenös verabreichten. Dies führte zu einer einige Stunden anhaltenden Schmerzreduktion. Zur Dauertherapie erhielt der Patient Buflomedil, um den Adenosinplasmaspiegel anzuheben. Damit konnte der Schmerz langfristig reduziert werden.

Die Adenosinmodulation stellt einen experimentellen Ansatz der Therapie von Ischämieschmerzen bei Thrombangiitis obliterans dar.

Abstract

Treating ischemic pain is often unsatisfactory. Current findings demonstrate that patients with chronic ischemia may develop sensory neuropathy and signs of central sensitization. This issue makes is reasonable treating with conventional analgesics and drugs against neuropathic pain. Adenosine has also a pain reducing effect in neuropathic pain which makes it a possible therapeutic option in ischemic pain.

We report of a patient with thromboangiitis obliterans. We treated his pain with a broad analgesic therapy and administered adenosine intravenously, which resulted in a reduction of pain for several hours. Afterwards the patient received buflomedil to increase adenosine plasma levels. A long term pain reduction could be achieved.

Modulation of adenosine demonstrates an experimental approach in the therapy of ischemic pain in thromboangiitis obliterans.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Belfrage M, Sollevi A, Segerdahl M et al. (1995) Systemic adenosine infusion alleviates spontaneous and stimulus evoked pain in patients with peripheral neuropathic pain. Anesth Analg 81: 713–717

    Article  PubMed  Google Scholar 

  2. Bleehen T, Keele CA (1977) Observations on the algogenic actions of adenosine compounds on the human blister base preparation. Pain 3: 367–377

    Article  PubMed  Google Scholar 

  3. Clissold SP, Lynch S, Sorkin EM (1987) Buflomedil. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in peripheral and cerebral vascular diseases. Drugs 33: 430–460

    PubMed  Google Scholar 

  4. De Backer TL, Vander Stichele RH, Bogaert MG (2001) Buflomedil for intermittent claudication. Cochrane Database Syst Rev CD000988

  5. Dworkin RH, Backonja M, Rowbotham MC et al. (2003) Advances in neuropathic pain – diagnosis, mechanisms, and treatment recommendations. Arch Neurol 60: 1524–1534

    Article  PubMed  Google Scholar 

  6. Eisenach JC, Curry R, Hood DD (2002) Dose response of intrathecal adenosine in experimental pain and allodynia. Anesthesiology 97: 938–942

    Article  PubMed  Google Scholar 

  7. Gleim M, Maier C, Melchert U (1995) Lumbar neurolytic sympathetic blockades provide immediate and long-lasting improvement of painless walking distance and muscle metabolism in patients with severe peripheral vascular disease. J Pain Symptom Manage 10: 98–104

    Article  PubMed  Google Scholar 

  8. Guieu R, Peragut JC, Roussel P et al. (1996) Adenosine and neuropathic pain. Pain 68: 271–274

    Article  PubMed  Google Scholar 

  9. Gyllenhammar E, Nordfors LO (2001) Systemic adenosine infusions alleviated neuropathic pain. Pain 94: 121–122

    Article  PubMed  Google Scholar 

  10. Hayashida M, Fukuda K, Fukunaga A (2005) Clinical application of adenosine and ATP for pain control. J Anesth 19: 225–235

    Article  PubMed  Google Scholar 

  11. Laghi PF, Capecchi PL, Acciavatti A et al. (1997) Pharmacological preconditioning of ischemia. Clin Hemorheol Microcirc 17: 73–84

    PubMed  Google Scholar 

  12. Lang PM, Schober GM, Rolke R et al. (2006) Sensory neuropathy and signs of central sensitization in patients with peripheral arterial disease. Pain 124: 190–200

    Article  PubMed  Google Scholar 

  13. Lang PM, Tracey DJ, Irnich D et al. (2002) Activation of adenosine and P2Y receptors by ATP in human peripheral nerve. Naunyn Schmiedebergs Arch Pharmacol 366: 449–457

    Article  PubMed  Google Scholar 

  14. Lynch ME, Clark AJ, Sawynok J (2003) Intravenous adenosine alleviates neuropathic pain: a double blind placebo controlled crossover trial using an enriched enrolment design. Pain 103: 111–117

    Article  PubMed  Google Scholar 

  15. Moser GH, Schrader J, Deussen A (1989) Turnover of adenosine in plasma of human and dog blood. Am J Physiol 256: C799–806

    PubMed  Google Scholar 

  16. Pardridge WM, Yoshikawa T, Kang YS, Miller LP (1994) Blood-brain barrier transport and brain metabolism of adenosine and adenosine analogs. J Pharmacol Exp Ther 268: 14–18

    PubMed  Google Scholar 

  17. Rane K, Sollevi A, Segerdahl M (2000) Intrathecal adenosine administration in abdominal hysterectomy lacks analgesic effect. Acta Anaesthesiol Scand 44: 868–872

    Article  PubMed  Google Scholar 

  18. Sawynok J (1998) Adenosine receptor activation and nociception. Eur J Pharmacol 347: 1–11

    Article  PubMed  Google Scholar 

  19. Segerdahl M, Ekblom A, Sollevi A (1994) The influence of adenosine, ketamine, and morphine on experimentally induced ischemic pain in healthy volunteers. Anesth Analg 79: 787–791

    Article  PubMed  Google Scholar 

  20. Ubbink DT, Vermeulen H, Spincemaille GH et al. (2004) Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischemia. Br J Surg 91: 948–955

    Article  PubMed  Google Scholar 

  21. Watt AH, Lewis DJ, Horne JJ, Smith PM (1987) Reproduction of epigastric pain of duodenal ulceration by adenosine. Br Med J (Clin Res Ed) 294: 10–12

    Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Die Autoren versichern, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung des Themas produktneutral.

Author information

Authors and Affiliations

  1. Interdisziplinäre Schmerzambulanz, Klinik für Anästhesiologieder Ludwig-Maximilians-Universität München, Klinikum Innenstadt , Pettenkoferstr. 8a, 80336, München, Deutschland

    Philip M. Lang & D. Irnich

Authors
  1. Philip M. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Irnich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip M. Lang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lang, P., Irnich, D. Adenosin zur Behandlung von Ischämieschmerzen bei Thrombangiitis obliterans. Schmerz 21, 234–237 (2007). https://doi.org/10.1007/s00482-007-0528-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00482-007-0528-5

Schlüsselwörter

Keywords

Search

Navigation