Use of anticonvulsants for treatment of neuropathic pain
Use of anticonvulsants for treatment of neuropathic pain
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DOI：
10.1212/wnl.59.5_suppl_2.s14
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发表时间：
2002-09-10
期刊：
影响因子：
9.9
通讯作者：
Backonja, MM
中科院分区：
文献类型：
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作者：
Backonja, MM
来自神经病理性疼痛动物模型的新证据表明，许多病理生理和生化变化发生在外周和中枢神经系统。在一些癫痫模型和神经性疼痛模型中观察到的病理生理学现象之间的相似性证明了在神经性疼痛的对症管理中使用抗惊厥药是合理的。实验室和临床试验的积极结果进一步支持这种使用。卡马西平是第一个在临床试验中研究的这类药物，并且在治疗神经性疼痛中使用时间最长。临床试验数据支持其用于治疗三叉神经痛，但治疗疼痛性糖尿病神经病变的数据不太令人信服。新型抗惊厥药的使用标志着神经性疼痛治疗进入了一个新时代。加巴喷丁已被证明有效，特别是在疼痛性糖尿病神经病变和带状疱疹后神经痛。据报道，拉莫三嗪可有效缓解其他治疗难治性三叉神经痛、HIV神经病变和卒中后中枢性疼痛。苯妥英临床试验的结果是模棱两可的。唑尼沙胺的作用机制表明，它将有效地控制神经性疼痛症状。其他抗惊厥药，包括劳拉西泮、丙戊酸盐、托吡酯和噻加宾，也在研究中。轶事经验为奥卡西平和左乙拉西坦治疗神经性疼痛的研究提供了支持。支持抗惊厥药治疗此类疼痛疗效的证据正在不断发展。更多的临床试验应提供信息，将更好地确定其在神经性疼痛中的作用。
Emerging evidence from animal models of neuropathic pain suggests that many pathophysiologic and biochemical changes occur in the peripheral and central nervous system. Similarities between the pathophysiologic phenomena observed in some epilepsy models and in neuropathic pain models justify the use of anticonvulsants in the symptomatic management of neuropathic pain. Positive results from laboratory and clinical trials further support such use. Carbamazepine was the first of this class of drugs to be studied in clinical trials and has been longest in use for treatment of neuropathic pain. Clinical trial data support its use in treating trigeminal neuralgia, but data for treatment of painful diabetic neuropathy are less convincing. Use of newer anticonvulsants has marked a new era in the treatment of neuropathic pain. Gabapentin has demonstrated efficacy, specifically in painful diabetic neuropathy and postherpetic neuralgia. Lamotrigine has been reported to be effective in relieving pain from trigeminal neuralgia refractory to other treatments, HIV neuropathy, and central post-stroke pain. Results from clinical trials of phenytoin are equivocal. Zonisamide's mechanisms of action suggest that it would be effective in controlling neuropathic pain symptoms. Other anticonvulsants, including lorazepam, valproate, topiramate, and tiagabine, have also been under investigation. Anecdotal experience provides support for studies with oxcarbazepine and levetiracetam for treating neuropathic pain. Evidence supporting the efficacy of anticonvulsants in treatment of such pain is evolving. Additional clinical trials should provide information that will better define their role in neuropathic pain.