Pharmacotherapy to Manage Central Post-Stroke Pain
Pharmacotherapy to Manage Central Post-Stroke Pain
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DOI：
10.1007/s40263-021-00791-3
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发表时间：
2021-02-07
期刊：
影响因子：
6
通讯作者：
Bottros, Michael M.
中科院分区：
文献类型：
--
作者：
Choi, Hanwool Ryan;Aktas, Adem;Bottros, Michael M.
中枢性卒中后疼痛是脑血管意外后的一种慢性神经病理性疼痛综合征。中枢性卒中后疼痛的发展估计发生在8%至55%的卒中患者中，并且被描述为持续或间歇性神经性疼痛，伴有温度和/或压力感觉的感觉迟钝。这些疼痛和感觉缺陷位于与中风病变相对应的身体区域内。疼痛的发作通常是渐进的，尽管它可以在中风后立即或数年后发展。鉴于其临床表现的多样性，中枢性卒中后疼痛是一个具有挑战性的排除诊断。此外，中枢性卒中后疼痛通常对药物治疗方案具有抵抗力，并且尚未建立明确的治疗算法。根据目前的证据，阿米替林、拉莫三嗪和加巴喷丁类药物应作为怀疑卒中后中枢性疼痛的一线药物治疗选择。其他药物，如氟伏沙明，类固醇，静脉输注利多卡因，氯胺酮，甚至异丙酚，可以考虑在难治性病例。此外，运动皮层刺激或经颅磁刺激等介入治疗已被证明可以缓解难以治疗的患者。
Central post-stroke pain is a chronic neuropathic pain syndrome following a cerebrovascular accident. The development of central post-stroke pain is estimated to occur in 8 to 55% of stroke patients and is described as constant or intermittent neuropathic pain accompanied by dysesthesia of temperature and/or pressure sensations. These pain and sensory deficits are within the area of the body corresponding to the stroke lesion. The onset of pain is usually gradual, though it can develop either immediately after stroke or years after. Given the diversity in its clinical presentation, central post-stroke pain is a challenging diagnosis of exclusion. Furthermore, central post-stroke pain is often resistant to pharmacological treatment options and a clear therapeutic algorithm has not been established. Based on current evidence, amitriptyline, lamotrigine, and gabapentinoids should be used as first-line pharmacotherapy options when central post-stroke pain is suspected. Other drugs, such as fluvoxamine, steroids, and Intravenous infusions of lidocaine, ketamine, or even propofol, can be considered in intractable cases. In addition, interventional therapies such as motor cortex stimulation or transcranial magnetic stimulation have been shown to provide relief in difficult-to-treat patients.