Vadalouca Athina, Siafaka Ioanna, Argyra Eriphylli, Vrachnou Evi, Moka Eleni
Department of Anaesthesiology, Pain Relief and Palliative Care, Aretaieion University Hospital, Lefkon Oreon Street, Gerakas, Athens, Greece.
Ann N Y Acad Sci. 2006 Nov;1088:164-86. doi: 10.1196/annals.1366.016.
Neuropathic pain is defined as pain caused by a lesion in the nervous system and is common in clinical practice. Diagnosis can be difficult. Recommendations for first-line pharmacologic treatments are based on positive results from multiple, randomized, controlled trials, and recommendations for second-line pharmacologic treatments are based on the positive result of a single, randomized, controlled trial or inconsistent results of multiple, randomized, controlled trials. The results of published trials and clinical experience provide the foundation for specific recommendations for first-line treatments, which include gabapentin, 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants (TCAs). Gabapentin (up to 3,600 mg/day) significantly reduced pain compared with placebo; improvements in sleep, mood, and quality of life were also demonstrated. Adverse effects of gabapentin include somnolence and dizziness, and, less commonly, gastrointestinal symptoms and mild peripheral edema. Thus, monitoring and dosage adjustment are required, without discontinuation of the drug. Gabapentin combined with morphine achieved better analgesia at lower doses of each drug than each drug alone, with only mild adverse effects. The first medication that proved effective for neuropathic pain in placebo-controlled trials was TCAs. Treatment decisions for patients with neuropathic pain can be difficult. Interest in the mechanisms and treatment of chronic neuropathic pain has increased during the past years, resulting in significant treatment advances in the future. In this article all recent knowledge on therapeutic management of chronic neuropathic pain is presented.
神经病理性疼痛被定义为由神经系统损伤引起的疼痛，在临床实践中很常见。诊断可能具有挑战性。一线药物治疗的推荐基于多项随机对照试验的阳性结果，二线药物治疗的推荐基于单个随机对照试验的阳性结果或多项随机对照试验的不一致结果。已发表试验的结果和临床经验为一线治疗的具体推荐提供了基础，这些推荐包括加巴喷丁、5%利多卡因贴剂、阿片类镇痛药、盐酸曲马多和三环类抗抑郁药（TCAs）。与安慰剂相比，加巴喷丁（每日剂量高达3600毫克）能显著减轻疼痛；睡眠、情绪和生活质量也有改善。加巴喷丁的不良反应包括嗜睡和头晕，较少见的有胃肠道症状和轻度外周水肿。因此，需要进行监测和剂量调整，但无需停药。加巴喷丁与吗啡联合使用时，每种药物的较低剂量比单独使用时能实现更好的镇痛效果，且只有轻微的不良反应。在安慰剂对照试验中被证明对神经病理性疼痛有效的第一种药物是三环类抗抑郁药。神经病理性疼痛患者的治疗决策可能很困难。在过去几年中，人们对慢性神经病理性疼痛的机制和治疗的兴趣有所增加，这将在未来带来显著的治疗进展。本文介绍了慢性神经病理性疼痛治疗管理的所有最新知识。
