Neuropathic Corneal Pain: Approaches for Management.
Neuropathic Corneal Pain: Approaches for Management.
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DOI：
10.1016/j.ophtha.2017.08.004
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发表时间：
2017-11
期刊：
影响因子：
13.7
通讯作者：
Hamrah P
中科院分区：
文献类型：
--
作者：
Dieckmann G;Goyal S;Hamrah P
神经性疼痛是由神经系统的原发性病变或功能障碍引起的，并且可以发生在角膜中。然而，神经性角膜疼痛（NCP）目前是一种定义不清的疾病。NCP患者的管理极具挑战性，并且针对NCP患者管理的循证临床建议很少。本综述的目的是为NCP患者的诊断和治疗提供指南，并总结该领域的现有循证文献。我们对1966年至2017年期间的所有相关出版物进行了系统性文献检索。治疗建议部分基于方法学合理的随机对照试验（RCT），证明优于安慰剂或相关对照治疗，以及证据的一致性，疗效和安全性。此外，这些建议包括我们自己在过去十年中管理这些患者的丰富经验。一个全面的算法，临床评价和补充测试的基础上，提出了NCP患者的诊断和亚分类。推荐的一线局部治疗包括神经再生和抗炎药，而一线全身药物治疗包括三环类抗抑郁药和抗惊厥药。推荐的二线口服治疗包括阿片类拮抗剂和阿片类镇痛药。补充和替代治疗，如有氧运动，针灸，欧米茄-3脂肪酸和无麸质饮食，可能有额外的好处，因为这样做的潜在的非侵入性和侵入性程序在消化不良的情况下。药物选择应根据个体情况，考虑副作用、合并症以及外周和中枢疼痛水平。然而，迫切需要长期的研究和随机对照试验来评估NCP治疗的疗效。
Neuropathic pain is caused by a primary lesion or dysfunction of the nervous system and can occur in the cornea. However, neuropathic corneal pain (NCP) is currently an ill-defined disease. Patients with NCP are extremely challenging to manage and evidence-based clinical recommendations for the management of patients with NCP are scarce. The objectives of this review are to provide guidelines for diagnosis and treatment of patients with NCP and to summarize current evidence-based literature in this area. We performed a systematic literature search of all relevant publications between 1966 and 2017. Treatment recommendations are, in part, based on methodologically sound randomized controlled trials (RCTs), demonstrating superiority to placebo or relevant control treatments, and on the consistency of evidence, degree of efficacy, and safety. In addition, the recommendations include our own extensive experience in the management of these patients over the past decade. A comprehensive algorithm, based on clinical evaluation and complementary tests, is presented for diagnosis and subcategorization of patients with NCP. Recommended first-line topical treatments include neuro-regenerative and anti-inflammatory agents, whilst first-line systemic pharmacotherapy includes tricyclic antidepressants and the anticonvulsant. Second line oral treatments recommended include the opioid-antagonist and opiate analgesics. Complementary and alternative treatments, such as cardio-exercise, acupuncture, omega-3 fatty acid, and gluten-free diet, may have additional benefits, as do potential non-invasive and invasive procedures in recalcitrant cases. Medication selection should be tailored on an individual basis, considering side effects, comorbidities, and levels of peripheral and centralized pain. Nevertheless, there is an urgent need for long-term studies and RCTs assessing the efficacy of treatments for NCP.
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DOI：
10.3233/jpd-140508
发表时间：
2015
期刊：
Journal of Parkinson's disease
影响因子：
--
作者：
Allen NE;Moloney N;van Vliet V;Canning CG
通讯作者：
Canning CG
DOI：
10.1016/j.jtos.2015.01.005
发表时间：
2015-07
期刊：
The ocular surface
影响因子：
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作者：
Aggarwal S;Kheirkhah A;Cavalcanti BM;Cruzat A;Colon C;Brown E;Borsook D;Prüss H;Hamrah P
通讯作者：
Hamrah P
影响因子：
13.7
作者：
Amparo, Francisco;Schaumberg, Debra A.;Dana, Reza
通讯作者：
Dana, Reza
影响因子：
5.1
作者：
Attal, N.;Cruccu, G.;Nurmikko, T.
通讯作者：
Nurmikko, T.
影响因子：
8.1
作者：
Amparo, Francisco;Dastjerdi, Mohammad H.;Okanobo, Andre;Ferrari, Giulio;Smaga, Leila;Hamrah, Pedram;Jurkunas, Ula;Schaumberg, Debra A.;Dana, Reza
通讯作者：
Dana, Reza