Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
Mayo Clin Proc. 2010 Mar;85(3 Suppl):S3-14. doi: 10.4065/mcp.2009.0649.
The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel alpha(2)-delta ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances. Results of several recent clinical trials have become available since the development of these guidelines. These studies have examined botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies in various neuropathic pain conditions. The increasing number of negative clinical trials of pharmacological treatments for neuropathic pain and ambiguities in the interpretation of these negative trials must also be considered in developing treatment guidelines. The objectives of the current article are to review the Neuropathic Pain Special Interest Group guidelines for the pharmacological management of neuropathic pain and to provide a brief overview of these recent studies.
国际疼痛研究协会神经病理性疼痛特别兴趣小组最近发起了制定基于循证的神经病理性疼痛药物治疗指南的工作。三环类抗抑郁药、双重 5-羟色胺和去甲肾上腺素再摄取抑制剂、钙通道 α2-δ 配体（如加巴喷丁和普瑞巴林）以及局部利多卡因，是根据随机临床试验结果被推荐作为一线治疗选择。阿片类镇痛药和曲马多则被推荐作为二线治疗药物，在某些临床情况下，也可以考虑作为一线药物使用。自这些指南制定以来，已有多项最近的临床试验结果公布。这些研究在各种神经病理性疼痛情况下，对肉毒毒素、高浓度辣椒素贴剂、拉科酰胺、选择性 5-羟色胺再摄取抑制剂和联合治疗进行了研究。越来越多的神经病理性疼痛药物治疗的阴性临床试验以及对这些阴性试验的解释不明确，也必须在制定治疗指南时加以考虑。本文的目的是回顾神经病理性疼痛特别兴趣小组的神经病理性疼痛药物治疗指南，并对这些最近的研究进行简要概述。
