Kerstman Eric, Ahn Sangmin, Battu Sree, Tariq Shabrez, Grabois Martin
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Handb Clin Neurol. 2013;110:175-87. doi: 10.1016/B978-0-444-52901-5.00015-0.
Neuropathic pain is a clinical entity that presents unique diagnostic and therapeutic challenges. This chapter addresses the classification, epidemiology, pathophysiology, diagnosis, and treatment of neuropathic pain syndrome. Neuropathic pain can be distinguished from nociceptive pain based on clinical signs and symptoms. Although neuropathic pain presents a significant burden to individuals and society, a more accurate assessment of resource utilization, costs, and impairments associated with neuropathic pain would facilitate appropriate planning of healthcare policies. The underlying pathophysiology of neuropathic pain is not well defined. Several theories regarding the mechanism of neuropathic pain have been proposed, including central and peripheral nervous system sensitization, deafferentation, neurogenic inflammation, and the wind up theory. Neuropathic pain is a clinical diagnosis and requires a systematic approach to assessment, including a detailed history, physical examination, and appropriate diagnostic testing. The mainstay of treatment for neuropathic pain is pharmacological, including the use of antidepressants, antiepileptics, topical anesthetics, and opioids. Nonpharmacological treatments include psychological approaches, physical therapy, interventional therapy, spinal cord stimulation, and surgical procedures. Neuropathic pain is difficult to treat, but a combination of therapies may be more effective than monotherapy. Clinical practice guidelines provide an evidence-based approach to the treatment of neuropathic pain.
神经性疼痛是一种具有独特诊断和治疗挑战的临床病症。本章论述神经性疼痛综合征的分类、流行病学、病理生理学、诊断及治疗。神经性疼痛可根据临床体征和症状与伤害感受性疼痛相区分。尽管神经性疼痛给个人和社会带来了沉重负担，但对与神经性疼痛相关的资源利用、成本及损伤进行更准确评估将有助于合理制定医疗保健政策。神经性疼痛的潜在病理生理学尚未明确界定。关于神经性疼痛机制已提出多种理论，包括中枢和外周神经系统敏化、去传入神经作用、神经源性炎症及“wind up”理论。神经性疼痛是一种临床诊断，需要采用系统的评估方法，包括详细的病史、体格检查及适当的诊断检测。神经性疼痛治疗的主要方法是药物治疗，包括使用抗抑郁药、抗癫痫药、局部麻醉药及阿片类药物。非药物治疗包括心理治疗方法、物理治疗、介入治疗、脊髓刺激及外科手术。神经性疼痛难以治疗，但联合治疗可能比单一治疗更有效。临床实践指南为神经性疼痛的治疗提供了循证方法。
