Treatment of Neuropathic Pain: An Overview of Recent Guidelines
Treatment of Neuropathic Pain: An Overview of Recent Guidelines
复制标题
DOI：
10.1016/j.amjmed.2009.04.007
复制
发表时间：
2009-10-01
影响因子：
5.9
通讯作者：
Dworkin, Robert H.
中科院分区：
文献类型：
--
作者：
O'Connor, Alec B.;Dworkin, Robert H.
已经研究了许多不同的神经性疼痛治疗方法，但文献数量庞大，发展迅速，缺乏关于患者管理实际方面的重要信息。在国际疼痛研究协会（IASP）神经性疼痛特别兴趣小组（NeuPSIG）的主持下，采用共识过程制定了基于证据的神经性疼痛药理学管理指南，该指南考虑了临床疗效、不良反应、对健康相关生活质量的影响、便利性和成本。在随机临床试验的基础上，推荐作为神经性疼痛一线治疗的药物包括某些抗抑郁药（即三环抗抑郁药和血清素和去甲肾上腺素的双重再摄取抑制剂）、钙通道α (2)- δ配体（即加巴喷丁和普瑞巴林）和外用利多卡因。阿片类镇痛药和曲马多被推荐为二线治疗，在选定的临床情况下可以考虑一线使用。其他通常用作三线治疗的药物包括某些其他抗抑郁药和抗癫痫药，局部辣椒素，美西汀和n -甲基- d-天冬氨酸受体拮抗剂。另外两个国家和国际协会最近发表了神经性疼痛的药物治疗指南，并与NeuPSIG的建议进行了总结和对比。最近的指南使用神经刺激治疗神经性疼痛也进行了总结。对于所有神经性疼痛的治疗，长期研究、头对头比较和治疗组合研究是未来研究的重点。(C) 2009爱思唯尔公司版权所有。美国医学杂志（2009）122,S22-S32
A number of different treatments for neuropathic pain have been studied, but the literature is sizable, rapidly evolving, and lacks important information about practical aspects of patient management. Under the auspices of the International Association for the Study of Pain (IASP) Neuropathic Pain Special Interest Group (NeuPSIG), a consensus process was used to develop evidence-based guidelines for the pharmacologic management of neuropathic pain that take into account clinical efficacy, adverse effects, impact on health-related quality of life, convenience, and costs. On the basis of randomized clinical trials, medications recommended as first-line treatments for neuropathic pain included certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel alpha(2)-delta ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications that generally would be used as third-line treatments include certain other antidepressant and antiepileptic medications, topical capsaicin, mexiletine, and N-methyl-D-aspartate receptor antagonists. Two other national and international associations recently published pharmacologic treatment guidelines for neuropathic pain, which are summarized and contrasted with the NeuPSIG recommendations. Recent guidelines for the use of neurostimulation for the treatment of neuropathic pain also are summarized. For all treatments for neuropathic pain, long-term studies, head-to-head comparisons, and studies of treatment combinations are a priority for future research. (C) 2009 Elsevier Inc. All rights reserved. The American Journal of Medicine (2009) 122, S22-S32