EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision
EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision
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DOI：
10.1111/j.1468-1331.2010.02999.x
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发表时间：
2010-09-01
影响因子：
5.1
通讯作者：
Nurmikko, T.
中科院分区：
文献类型：
--
作者：
Attal, N.;Cruccu, G.;Nurmikko, T.
背景和目的：第二届欧洲神经学会联合会特别工作组旨在更新自2005年以来关于神经病理性疼痛的药物治疗的现有证据。方法：利用Cochrane数据库和Medline进行研究。试验根据病因学条件进行分类。所有的I类和II类随机对照试验(RCT)都进行了评估；只有在没有顶级研究的情况下，才考虑进行较低级别的研究。结果：大多数大型随机对照试验包括糖尿病多发性神经病和带状疱疹后神经痛的患者，而越来越多的小型研究探索了其他情况。除三叉神经痛、慢性神经根病和艾滋病毒神经病外，药物在各种情况下通常具有类似的疗效，A级证据支持三环类抗抑郁药(TCA)、普瑞巴林、加巴喷丁、曲马多和阿片类药物(在各种情况下)、度洛西汀、文拉法辛、局部利多卡因和辣椒素贴片(在限制条件下)。联合治疗对三氯乙酸-加巴喷丁和加巴喷丁-阿片类药物(A级)有效。结论：大规模对比研究仍然太少。在未来的试验中，我们建议使用标准化工具评估合并症、生活质量、症状和体征，并尝试更好地定义特定药物治疗的应答者概况。
Background and objectives:This second European Federation of Neurological Societies Task Force aimed at updating the existing evidence about the pharmacological treatment of neuropathic pain since 2005.Methods:Studies were identified using the Cochrane Database and Medline. Trials were classified according to the aetiological condition. All class I and II randomized controlled trials (RCTs) were assessed; lower class studies were considered only in conditions that had no top-level studies. Treatments administered using repeated or single administrations were considered, provided they are feasible in an outpatient setting.Results:Most large RCTs included patients with diabetic polyneuropathies and post-herpetic neuralgia, while an increasing number of smaller studies explored other conditions. Drugs generally have similar efficacy in various conditions, except in trigeminal neuralgia, chronic radiculopathy and HIV neuropathy, with level A evidence in support of tricyclic antidepressants (TCA), pregabalin, gabapentin, tramadol and opioids (in various conditions), duloxetine, venlafaxine, topical lidocaine and capsaicin patches (in restricted conditions). Combination therapy appears useful for TCA-gabapentin and gabapentin-opioids (level A).Conclusions:There are still too few large-scale comparative studies. For future trials, we recommend to assess comorbidities, quality of life, symptoms and signs with standardized tools and attempt to better define responder profiles to specific drug treatments.