School of Medicine and Biomedical Sciences, University at Buffalo, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Pain Med. 2011 Jul;12 Suppl 3:S100-8. doi: 10.1111/j.1526-4637.2011.01160.x.
Neuropathic pain often imposes a substantial and unrelenting burden on those individuals who have it; single-agent analgesics typically only reduce pain at best. Worldwide, five sets of treatment recommendations offer insight into managing neuropathic pain, including two European guidelines, one Canadian, one Latin American, and another constructed under the auspices of the International Association for the Study of Pain (IASP). The analgesics common to these guidelines are topical lidocaine, secondary amine tricyclic antidepressants, serotonin and norepinephrine dual reuptake inhibitors, calcium channel α(2)-δ ligands, tramadol, and opioid antagonists. Still, significant knowledge gaps in the treatment of neuropathic pain conditions have hampered the development of algorithms and multimodal approaches. As the evidence base expands, the addition of new comparative trial data will further refine the development of new guidance for clinical management of neuropathic pain. New alternatives for managing neuropathic pain, such as the high-concentration capsaicin patch, will enlarge the treatment armamentarium and potentially impact therapeutic guidelines.
神经病理性疼痛常给患者带来沉重且持续的负担；单一镇痛药物最多只能缓解疼痛。全球有五套治疗推荐方案可用于管理神经病理性疼痛，包括两套欧洲指南、一套加拿大指南、一套拉丁美洲指南和一套由国际疼痛研究协会（IASP）制定的指南。这些指南中常见的镇痛药有局部利多卡因、第二代单胺三环抗抑郁药、5-羟色胺和去甲肾上腺素再摄取双重抑制剂、钙通道α(2)-δ配体、曲马多和阿片受体拮抗剂。然而，神经病理性疼痛治疗方面仍存在重大知识空白，这阻碍了算法和多模式方法的发展。随着证据基础的扩大，新的对照试验数据的加入将进一步完善神经病理性疼痛临床管理新指南的制定。管理神经病理性疼痛的新方法，如高浓度辣椒素贴剂，将扩大治疗手段，并可能影响治疗指南。
