Post-traumatic pain. Causes and therapeutic concepts

Each patient has the right of a dedicated pain therapy according to the sta te of the art. However an efficient pain therapy is not possible without kn owing the cause of pain. In most posttraumatic pain situations peripheral n ociceptors are activated and normal afferences are conducted via an intact nociceptive system. In contrast, neuropathic pain pain is caused by lesions of the nervous system itself. Mechanisms of central sensibilization and in volvement of the sympathetic nervous system may lead to chronification of s uch pain conditions. The therapeutic regime of nociceptive and neuropathic pain is demonstrated by algorithms of treatment modalities. Apart from clas sic non-opioid analgesics, co-analgesics and opioids have an important stat us in chronic pain management as well. Prescription of these substances has to follow strictly defined standards of pain therapy. Blockades with local anaesthetics as mono-therapy of chronic pain are obsolete. In posttraumati c pain, however, a certain number of adjuvant blockades or infiltrations of triggerpoints may be helpful. The exeptional place of sympathetic blockade s are in diagnosis and therapy of sympathetic maintained pain (SMP).