Wolfe Gil I, Hotz Susan E, Barohn Richard J
From the Departments of Neurology, *University of Texas Southwestern Medical Center, Dallas, Texas, and the daggerUniversity of Kansas Medical Center, Kansas City, Kansas.
J Clin Neuromuscul Dis. 2002 Dec;4(2):50-9. doi: 10.1097/00131402-200212000-00002.
Treatment of neuropathic pain is the primary focus of management for many patients with painful peripheral neuropathies. Antidepressants and anticonvulsants are the two medication classes most widely studied and represent first-line agents in the management of neuropathic pain. The number of pharmacologic agents and interventional procedures that have shown effectiveness in the treatment of neuropathic pain continues to expand. Pain management should begin with a concerted effort to identify the etiology of the neuropathy, because directed therapy can help alleviate the symptoms. When initiating pharmacotherapy for neuropathic pain, one must individualize treatment and choose an agent that is likely to be tolerated, because adverse events are common for many of these agents. Neuropathic pain management remains challenging because of heterogeneous responses between individuals and the fact that pain relief is rarely complete. However, monotherapy with a well-chosen agent or rational polypharmacy that combines medications with different mechanisms of action will benefit a majority of patients with neuropathic pain.
对于许多患有疼痛性周围神经病变的患者，神经性疼痛的治疗是管理的主要重点。抗抑郁药和抗惊厥药是研究最为广泛的两类药物，也是神经性疼痛管理中的一线药物。已证明对神经性疼痛治疗有效的药物和介入程序的数量在不断增加。疼痛管理应首先共同努力确定神经病变的病因，因为针对性治疗有助于缓解症状。在开始针对神经性疼痛进行药物治疗时，必须个体化治疗并选择一种可能被耐受的药物，因为这些药物中的许多都有常见的不良事件。由于个体之间反应的异质性以及疼痛缓解很少完全实现这一事实，神经性疼痛的管理仍然具有挑战性。然而，使用精心选择的单一药物或合理的联合用药（将具有不同作用机制的药物联合使用）将使大多数神经性疼痛患者受益。
