Jensen Troels S, Finnerup Nanna Brix
Department of Neurology and Danish Pain Research Center, Aarhus University, Aarhus, Denmark.
Curr Opin Support Palliat Care. 2007 Aug;1(2):126-31. doi: 10.1097/SPC.0b013e3282eeb45f.
Neuropathic pain is a chronic pain condition arising from injury or disease of the peripheral or central nervous system with a substantial impact on quality of life. This brief review focuses on the increasing evidence for effective treatments and discusses an evidence-based algorithm for treating neuropathic pain conditions.
Randomized controlled trials have consistently shown efficacy of tricyclic antidepressants, gabapentin/pregabalin, opioids, tramadol, and serotonin and noradrenaline-reuptake inhibitors for the treatment of various neuropathic pain conditions, lidocaine patches for postherpetic neuralgia and cannabinoids for pain in multiple sclerosis. Carbamazepine or oxcarbazepine is the treatment of choice for trigeminal neuralgia. The efficacy of these drugs in other neuropathic pain conditions as well as the efficacy of lamotrigine and topical capsaicin is questionable, but they may be useful in a subgroup of patients.
For each patient, considerations on the underlying pain mechanisms, immediate and potential long-term side effects, and price as well as comorbidities and concurrent medications will decide which drug should be the first choice, but until further progress is made towards a mechanism-based classification, treatment is likely to be a trial-and-error process where drug combinations may also be considered.
神经性疼痛是一种由外周或中枢神经系统损伤或疾病引起的慢性疼痛病症，对生活质量有重大影响。本简要综述着重于有效治疗方法的证据日益增多，并讨论一种基于证据的治疗神经性疼痛病症的算法。
随机对照试验一直表明，三环类抗抑郁药、加巴喷丁/普瑞巴林、阿片类药物、曲马多以及5-羟色胺和去甲肾上腺素再摄取抑制剂对治疗各种神经性疼痛病症有效，利多卡因贴剂对带状疱疹后神经痛有效，大麻素对多发性硬化症疼痛有效。卡马西平或奥卡西平是三叉神经痛的首选治疗药物。这些药物在其他神经性疼痛病症中的疗效以及拉莫三嗪和外用辣椒素的疗效存在疑问，但它们可能对一部分患者有用。
对于每位患者，对潜在疼痛机制、即刻和潜在的长期副作用、价格以及合并症和同时服用的药物的考虑将决定哪种药物应作为首选，但在基于机制的分类取得进一步进展之前，治疗可能是一个试错过程，其中也可能考虑药物联合使用。
