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Somatoforme Schmerzen: hirnphysiologische Aspekte

Douleurs psychosomatiques: aspects physiologiques

Psychosomatic pain: neurobiological aspects

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Zusammenfassung

Nicht hinreichend durch körperlich medizinische Befunde erklärbare (somatoforme) Schmerzen im Rücken und Nacken können durch psychosozialen Stress oder auch durch traumatische Erfahrungen bedingt und – jederzeit abrufbar – im "Schmerzgedächtnis" gespeichert sein, selbst wenn die peripheren "Schmerzsensoren" (Nozizeptoren und C-Fasern) überhaupt nicht erregt sind. Wie mit bildgebenden Verfahren gezeigt, korrelieren sie in der Regel mit der neuronalen Aktivität in der Schmerzmatrix des limbischen Systems, können jedoch durch gewisse kognitive Interventionen gelindert werden, etwa durch Ablenkungsstrategien oder operante Konditionierung mittels Neurofeedback. Durch Letztere kann aber die Aktivität in der Schmerzmatrix nicht nur vermindert, sondern – bei entsprechender Motivation – auch erhöht werden. Damit wird nun vorstellbar, wie sich psychosomatische Schmerzen z. B. bei "sekundärem Krankheitsgewinn" verstärken können und sogar chronisch werden – durch (erlernte) nachhaltige Veränderungen in der neuronalen Aktivität des limbischen Systems, insbesondere des anterioren Gyrus cinguli.

Abstract

Psychosomatic pain may be related to mental or social stress but may also result from traumatic experience stored in the pain memory. It usually correlates with neuronal activity in the so-called pain matrix of the limbic system (particularly the anterior cingulate) rather than with nervous activity originating in C-fibres and nociceptors. Significantly, pain as well as neuronal activity in the cingulate may be modified by cognitive factors such as attention or distraction but also by operant conditioning involving "neurofeedback" guided by real-time functional magnetic resonance imaging. Given certain psychosocial rewards learning by operant conditioning may therefore well be involved in, and (partly) account for, the aggravation and chronification of psychosomatic pain as well as for alterations in the pain matrix that are often observed in patients suffering from chronic backache.

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Correspondence to Johann Caspar Rüegg.

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Rüegg, J. Somatoforme Schmerzen: hirnphysiologische Aspekte. Psychotherapie Forum 16, 15–21 (2008). https://doi.org/10.1007/s00729-008-0222-9

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