Neuropathic Pain: Principles of Diagnosis and Treatment
Neuropathic Pain: Principles of Diagnosis and Treatment
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DOI：
10.1016/j.mayocp.2015.01.018
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发表时间：
2015-04-01
影响因子：
8.9
通讯作者：
Jensen, Troels
中科院分区：
文献类型：
--
作者：
Gilron, Ian;Baron, Ralf;Jensen, Troels
神经性疼痛是由神经系统疾病或损伤引起的，包括各种慢性病，这些慢性病共同影响了高达 8% 的人口。大量的神经病理性疼痛研究指出了几个重要的促成机制，包括伤害性神经的异常异位活动、外周和中枢敏化、抑制调节受损以及小胶质细胞的病理激活。神经性疼痛的临床评估需要全面的病史和体格检查，以确定特征性体征和症状。在许多情况下，其他实验室检查和临床神经生理学测试可能有助于确定潜在的病因并指导治疗选择。现有的治疗基本上只能缓解症状，可能包括非药物治疗、药物治疗和介入治疗。药物治疗有最广泛的证据，目前推荐的一线治疗包括抗抑郁药（三环类药物和血清素-去甲肾上腺素再摄取抑制剂）和抗惊厥药（加巴喷丁和普瑞巴林）。通过仔细考虑与疼痛相关的残疾（例如抑郁和职业功能障碍）以及患者教育，可以促进个性化的多学科患者护理；重复随访并战略转诊至适当的内科/外科亚专业；以及身体和心理治疗。在不久的将来，持续的临床前和临床研究与开发预计将导致神经性疼痛的诊断和治疗取得进一步进展。 (C) 2015 年梅奥医学教育和研究基金会。
Neuropathic pain is caused by disease or injury of the nervous system and includes various chronic conditions that, together, affect up to 8% of the population. A substantial body of neuropathic pain research points to several important contributory mechanisms including aberrant ectopic activity in nociceptive nerves, peripheral and central sensitization, impaired inhibitory modulation, and pathological activation of microglia. Clinical evaluation of neuropathic pain requires a thorough history and physical examination to identify characteristic signs and symptoms. In many cases, other laboratory investigations and clinical neurophysiological testing may help identify the underlying etiology and guide treatment selection. Available treatments essentially provide only symptomatic relief and may include nonpharmacological, pharmacological, and interventional therapies. Most extensive evidence is available for pharmacological treatment, and currently recommended first-line treatments include antidepressants (tricyclic agents and serotonin-norepinephrine reuptake inhibitors) and anticonvulsants (gabapentin and pregabalin). Individualized multidisciplinary patient care is facilitated by careful consideration of pain-related disability (eg, depression and occupational dysfunction) as well as patient education; repeat follow-up and strategic referral to appropriate medical/surgical subspecialties; and physical and psychological therapies. In the near future, continued preclinical and clinical research and development are expected to lead to further advancements in the diagnosis and treatment of neuropathic pain. (C) 2015 Mayo Foundation for Medical Education and Research.