Gilron Ian, Max Mitchell B
Queen's University, Department of Anaesthesiology, c/o Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
Expert Rev Neurother. 2005 Nov;5(6):823-30. doi: 10.1586/14737175.5.6.823.
Current drugs reduce neuropathic pain and improve mood and quality of life. However, as single agents they are limited by incomplete efficacy and dose-limiting adverse effects. Recent experimental and clinical data support the potential of combination pharmacotherapy for neuropathic pain. Therapeutic benefits may include greater efficacy, lower doses and fewer adverse effects. Due to potential adverse, as well as beneficial, drug interactions, safety and efficacy of specific combinations must be empirically evaluated. Techniques such as isobolographic analysis, response-surface modeling and other model-free tests have been used in order to characterize analgesic interactions as antagonistic, additive or synergistic. Whether synergistic or not, a clinically useful combination could simply have additive or even subadditive analgesia, provided that there is less additivity for side effects. Despite widespread clinical use, there are surprisingly few published observations on combination therapy for neuropathic pain. This review discusses future directions and proposes research strategies aimed at bridging current knowledge gaps, including safety, compliance and cost-effectiveness; discovering optimal drug combinations and dose ratios; comparing concurrent with sequential combination therapy; and combining more than two drugs. Continued close integration of basic and clinical sciences is crucial in further harnessing the potential of combination pharmacotherapy in neuropathic pain.
目前的药物可减轻神经性疼痛，改善情绪和生活质量。然而，作为单一药物，它们存在疗效不完全和剂量限制性不良反应的局限性。最近的实验和临床数据支持联合药物疗法治疗神经性疼痛的潜力。治疗益处可能包括更高的疗效、更低的剂量和更少的不良反应。由于存在潜在的不良药物相互作用以及有益的药物相互作用，特定联合用药的安全性和疗效必须通过经验评估。诸如等效应线分析、响应面建模和其他无模型测试等技术已被用于将镇痛相互作用表征为拮抗、相加或协同作用。无论是否具有协同作用，只要副作用的相加性较小，临床上有用的联合用药可能仅具有相加甚至亚相加的镇痛作用。尽管联合疗法在临床上广泛应用，但令人惊讶的是，关于神经性疼痛联合治疗的已发表观察结果很少。本综述讨论了未来的方向，并提出了旨在弥合当前知识差距的研究策略，包括安全性、依从性和成本效益；发现最佳药物组合和剂量比；比较同时联合治疗与序贯联合治疗；以及联合使用两种以上药物。基础科学与临床科学的持续紧密结合对于进一步挖掘联合药物疗法治疗神经性疼痛的潜力至关重要。
