Sommer Claudia
Department of Neurology, University of Würzburg, Würzburg, Germany.
Curr Opin Neurol. 2003 Oct;16(5):623-8. doi: 10.1097/01.wco.0000093106.34793.06.
To summarize the current understanding of clinical assessment, pathophysiology, and treatment of pain in neuropathies, focusing on selected entities in which the understanding of the mechanisms underlying pain has advanced recently.
Ongoing studies are classifying the symptoms and signs of painful neuropathies, assuming that this approach may indicate particular pathomechanisms leading to more rational treatment. Nerve injury induces a large number of cellular changes, the relevance of which for the occurrence of pain is still under investigation. In models of diabetic neuropathy, an altered distribution of sodium channels, hyperexcitability of neurons, and changes in spinal connectivity seem to underlie the development of pain. The role of inflammatory mediators has been explored in inflammatory and degenerative neuropathies. Second messenger pathways contributing to hyperalgesia in various neuropathies have been identified, opening up new treatment options. A number of newer and older drugs have been studied for their use in painful neuropathies in clinical trials. Epidemiology has shown that, despite the availability of drugs with moderate efficacy in the treatment of neuropathic pain, a large percentage of patients do not gain access to them.
Advances in the standardization of assessment of patients with painful neuropathies are beginning to have an impact on how clinical studies are designed. Major progress has been made in the understanding of cellular and molecular changes after nerve injury, but their relevance for the pathophysiology of pain in neuropathies has still to be determined.
总结目前对神经病变性疼痛的临床评估、病理生理学及治疗的认识，重点关注近期对疼痛潜在机制的理解有所进展的特定类型。
正在进行的研究对疼痛性神经病变的症状和体征进行分类，认为这种方法可能提示导致更合理治疗的特定病理机制。神经损伤会引发大量细胞变化，其与疼痛发生的相关性仍在研究中。在糖尿病性神经病变模型中，钠通道分布改变、神经元过度兴奋以及脊髓连接变化似乎是疼痛发生的基础。炎症介质在炎症性和退行性神经病变中的作用已得到探索。已确定多种神经病变中导致痛觉过敏的第二信使途径，从而开辟了新的治疗选择。在临床试验中，对多种新旧药物用于疼痛性神经病变的情况进行了研究。流行病学表明，尽管有对治疗神经病理性疼痛疗效中等的药物，但很大比例的患者无法获得这些药物。
疼痛性神经病变患者评估标准化方面的进展开始影响临床研究的设计方式。在理解神经损伤后的细胞和分子变化方面取得了重大进展，但其与神经病变性疼痛病理生理学的相关性仍有待确定。
