Kuntzer Thierry, Decosterd Isabelle
Unité nerf-muscle, Service de neurologie, CHUV, 1011 Lausanne.
Rev Med Suisse. 2005 Nov 30;1(43):2812-6.
Neuropathic pains are frequent with better understood underlying mechanisms. The introduction of a new questionnaire, named DN4 (neuropathic pain 4 questions) will certainly be useful to prevent persistent pain. Here we describe current approaches to diagnosis and pharmacological treatments. Antidepressants, anticonvulsants, opioids and topical local anesthetics are part of the evidence-based approach, alone or in combination. The choice of the drug is based on the type of pain, a predominantly diffused pain being firstly treated with tricyclic antidepressants, whereas paroxysmal and localized pain being more adequately treated with anti-epileptics. Pregabaline, the newest anticonvulsant launched in the Swiss market, appears to be effective as a treatment of painful diabetic polyneuropathy and postherpetic neuralgia.
神经病理性疼痛很常见，其潜在机制也得到了更好的理解。一种名为DN4（神经病理性疼痛4个问题）的新问卷的引入，对于预防持续性疼痛肯定会很有用。在此，我们描述当前的诊断方法和药物治疗方法。抗抑郁药、抗惊厥药、阿片类药物和局部外用麻醉剂是循证治疗方法的一部分，可单独使用或联合使用。药物的选择基于疼痛类型，弥漫性为主的疼痛首先用三环类抗抑郁药治疗，而阵发性和局部性疼痛用抗癫痫药治疗更为合适。普瑞巴林是瑞士市场上推出的最新抗惊厥药，似乎对治疗糖尿病性周围神经病变性疼痛和带状疱疹后神经痛有效。
