Chong M Sam, Bajwa Zahid H
Department of Neurology, King's College Hospital, London, and The Medway Hospital, Gillingham, Kent, UK.
J Pain Symptom Manage. 2003 May;25(5 Suppl):S4-S11. doi: 10.1016/s0885-3924(03)00064-2.
Currently, no consensus on the optimal management of neuropathic pain exists and practices vary greatly worldwide. Possible explanations for this include difficulties in developing agreed diagnostic protocols and the coexistence of neuropathic, nociceptive and, occasionally, idiopathic pain in the same patient. Also, neuropathic pain has historically been classified according to its etiology (e.g., painful diabetic neuropathy, trigeminal neuralgia, spinal cord injury) without regard for the presumed mechanism(s) underlying the specific symptoms. A combined etiologic/mechanistic classification might improve neuropathic pain management. The treatment of neuropathic pain is largely empirical, often relying heavily on data from small, generally poorly-designed clinical trials or anecdotal evidence. Consequently, diverse treatments are used, including non-invasive drug therapies (antidepressants, antiepileptic drugs and membrane stabilizing drugs), invasive therapies (nerve blocks, ablative surgery), and alternative therapies (e.g., acupuncture). This article reviews the current and historical practices in the diagnosis and treatment of neuropathic pain, and focuses on the USA, Europe and Japan.
目前，对于神经性疼痛的最佳管理尚无共识，全球范围内的治疗方法差异很大。对此可能的解释包括难以制定公认的诊断方案，以及同一患者中神经性、伤害性和偶尔特发性疼痛并存。此外，神经性疼痛在历史上一直根据其病因进行分类（例如，疼痛性糖尿病神经病变、三叉神经痛、脊髓损伤），而不考虑特定症状背后的假定机制。病因/机制联合分类可能会改善神经性疼痛的管理。神经性疼痛的治疗很大程度上是经验性的，通常严重依赖于来自小型、普遍设计不佳的临床试验的数据或轶事证据。因此，使用了多种治疗方法，包括非侵入性药物疗法（抗抑郁药、抗癫痫药和膜稳定药物）、侵入性疗法（神经阻滞、消融手术）和替代疗法（例如针灸）。本文回顾了神经性疼痛诊断和治疗的当前及历史实践，并重点关注美国、欧洲和日本。
