The evidence for pharmacological treatment of neuropathic pain
The evidence for pharmacological treatment of neuropathic pain
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DOI：
10.1016/j.pain.2010.06.019
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发表时间：
2010-09-01
期刊：
影响因子：
7.4
通讯作者：
Jensen, Troels Staehelin
中科院分区：
文献类型：
--
作者：
Finnerup, Nanna Brix;Sindrup, Soren Hein;Jensen, Troels Staehelin
关于神经病理性疼痛治疗的随机、双盲、安慰剂对照试验正在积累，因此需要对现有证据进行最新审查。通过MEDLINE和EMBASE检索对研究进行鉴定。需要治疗的数量(NNT)和需要伤害的数量(NNH)值被用来比较不同治疗方法对一些神经病理性疼痛情况的有效性和安全性。纳入了174项研究，在过去5年中，发表的随机、安慰剂对照试验增加了66%。69项研究检查了痛性多发性神经病(最常见的原因是糖尿病)，23项检查了带状疱疹后神经痛，而周围神经损伤、中枢性疼痛、HIV神经病和三叉神经痛则较少被研究。三环类抗抑郁药、5-羟色胺去甲肾上腺素再摄取抑制剂、抗惊厥药加巴喷丁和普瑞巴林，以及阿片类药物是有最好证据证明其临床相关效果的药物类别。尽管已发表的试验增加了66%，但神经性疼痛的治疗只获得了有限的改善。很大比例的神经性疼痛患者没有得到足够的疼痛缓解。这一事实要求有其他治疗选择来针对慢性神经病理性疼痛。需要进行大规模药物试验，以确定可能对特定药物有反应的患者亚群，以检验基于机制的分类可能有助于改善对个别患者的治疗的假设。(C)2010年国际疼痛研究协会。爱思唯尔出版，版权所有。
Randomized, double-blind, placebo-controlled trials on neuropathic pain treatment are accumulating, so an updated review of the available evidence is needed. Studies were identified using MEDLINE and EMBASE searches. Numbers needed to treat (NNT) and numbers needed to harm (NNH) values were used to compare the efficacy and safety of different treatments for a number of neuropathic pain conditions. One hundred and seventy-four studies were included, representing a 66% increase in published randomized, placebo-controlled trials in the last 5 years. Painful poly-neuropathy (most often due to diabetes) was examined in 69 studies, postherpetic neuralgia in 23, while peripheral nerve injury, central pain, HIV neuropathy, and trigeminal neuralgia were less often studied. Tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, the anticonvulsants gabapentin and pregabalin, and opioids are the drug classes for which there is the best evidence for a clinical relevant effect. Despite a 66% increase in published trials only a limited improvement of neuropathic pain treatment has been obtained. A large proportion of neuropathic pain patients are left with insufficient pain relief. This fact calls for other treatment options to target chronic neuropathic pain. Large-scale drug trials that aim to identify possible subgroups of patients who are likely to respond to specific drugs are needed to test the hypothesis that a mechanism-based classification may help improve treatment of the individual patients. (C) 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.