Vurdelja Ranka Baraba, Budincević Hrvoje, Prvan Miljenka Planjar
Opća bolnica "Sveti Duh", Zavod za neurologiju, 10000 Zagreb.
Lijec Vjesn. 2008 Jul-Aug;130(7-8):191-5.
Central poststroke pain is a type of neuropathic pain which is caused by damage to the central nervous system after a stroke and which is localized to the territory of the neurological deficit which corresponds to the cerebrovascular lesion. Stroke is the commonest cause of central neuropathic pain. The purpose of this paper is to draw attention to the importance of this disorder and briefly summarize some clinical aspects and proposed pathophysiological mechanisms on which the rational therapy is based. Due to the lack of randomized controlled trials about the efficacy of the pharmacological treatment, therapeutic guidelines are based also on clinical experience, uncontrolled studies and experts' opinion. According to international guidelines for the treatment of central poststroke pain, the first line therapy is tricyclic antidepressants (amytriptilin and nortriptilin) or antiepileptic drugs (lamotrigine, gabapentine, pregabaline, carbamazepine). The second line is tramadol, opioids and fluvoxamin.
脑卒中后中枢性疼痛是一种神经性疼痛，由脑卒中后中枢神经系统受损引起，局限于与脑血管病变相对应的神经功能缺损区域。脑卒中是中枢性神经性疼痛最常见的病因。本文旨在提请人们注意这种疾病的重要性，并简要总结一些临床方面以及合理治疗所基于的病理生理机制。由于缺乏关于药物治疗疗效的随机对照试验，治疗指南也基于临床经验、非对照研究和专家意见。根据国际上关于脑卒中后中枢性疼痛的治疗指南，一线治疗药物是三环类抗抑郁药（阿米替林和去甲替林）或抗癫痫药物（拉莫三嗪、加巴喷丁、普瑞巴林、卡马西平）。二线治疗药物是曲马多、阿片类药物和氟伏沙明。
