Polatin Peter B, Dersh Jeffrey
Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center at Dallas, Eugene McDermott Center for Pain Management, 6263 Harry Hines Blvd., Dallas, TX 75235, USA.
Spine J. 2004 Jul-Aug;4(4):436-50. doi: 10.1016/j.spinee.2004.01.012.
Optimal treatment of nonmalignant chronic spinal disorders (CSDs) may require the use of one or more nonopioid psychotropic medications. Vast research literature has documented high rates of psychiatric disorders in patients with CSDs. Psychotropic medications are one type of effective treatment for these disorders. Many medications of this type are also used as adjuvants to primary analgesic medications.
Physicians treating CSDs may have little training and experience in prescribing psychotropic medications. Further, they may possess limited information about the efficacy of these types of medications in treating psychiatric disorders comorbid with CSDs or as adjunctive analgesics. Because of the wide variety (antidepressants, anxiolytics, sleep-promoting agents, anticonvulsants, neuroleptics, muscle relaxants) and numerous indications for psychiatric medications, a concise review of the use of psychotropic medications with CSD patients is offered for the spine specialist.
A systematic review of the contemporary English literature on psychotropic medications in the CSD population.
A computerized search of MEDLINE was performed on all English literature published from 1982 to August 2002.
Psychotropic medications have been found to be very efficacious in the large subgroup of patients with CSDs with psychiatric comorbidity, particularly patients with the common constellation of depression, anxiety, excessive somatic complaints, insomnia and irritability. Although the type of medication indicated depends on the particular psychiatric syndrome(s), antidepressants have been found to be extremely useful with the constellation described above. There is less evidence to support the use of nonopioid psychotropic medications in the treatment of nociceptive pain, although clinical experience indicates that some individuals demonstrate a marked analgesic response. Research support for the efficacy of particular psychotropic medications in treating neuropathic pain is stronger, although more controlled research is clearly needed.
Psychotropic medications are extremely useful in the treatment of psychiatric disorders comorbid with CSDs and modestly useful as analgesic adjuvants, particularly with pain of neuropathic etiology. Familiarity with these medications will aid the primary treating physician in optimizing outcomes in this difficult group of patients.
非恶性慢性脊柱疾病（CSDs）的最佳治疗可能需要使用一种或多种非阿片类精神药物。大量研究文献表明，CSDs患者中精神疾病的发生率很高。精神药物是治疗这些疾病的一种有效方法。这类药物中的许多也被用作主要镇痛药的辅助药物。
治疗CSDs的医生在开具精神药物处方方面可能缺乏培训和经验。此外，他们可能对这类药物治疗与CSDs共病的精神疾病或作为辅助镇痛药的疗效了解有限。由于精神药物种类繁多（抗抑郁药、抗焦虑药、促眠药、抗惊厥药、抗精神病药、肌肉松弛剂）且适应证众多，本文为脊柱专科医生提供了一份关于CSDs患者使用精神药物的简要综述。
对当代关于CSDs人群中精神药物的英文文献进行系统综述。
对1982年至2002年8月发表的所有英文文献进行MEDLINE计算机检索。
已发现精神药物在患有精神疾病共病的CSDs患者的大部分亚组中非常有效，特别是那些具有抑郁、焦虑、过度躯体不适、失眠和易怒等常见症状的患者。虽然所使用的药物类型取决于特定的精神综合征，但已发现抗抑郁药对上述症状极为有用。支持使用非阿片类精神药物治疗伤害性疼痛的证据较少，尽管临床经验表明一些个体表现出明显的镇痛反应。关于特定精神药物治疗神经性疼痛疗效的研究支持更强，尽管显然需要更多对照研究。
精神药物在治疗与CSDs共病的精神疾病方面极其有用，作为镇痛辅助药物也有一定作用，特别是对于神经性病因的疼痛。熟悉这些药物将有助于初级治疗医生优化这类难治性患者的治疗效果。
