Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
J Pain Symptom Manage. 2013 Oct;46(4):581-590.e1. doi: 10.1016/j.jpainsymman.2012.10.230. Epub 2013 Feb 12.
The prevalence of neuropathic pain in patients with cancer pain has been estimated to be around 40%. Neuropathic pain may be caused by tumor invasion and is considered as mixed nociceptive-neuropathic pain, or caused by an anticancer treatment and considered as purely neuropathic pain. The use of adjuvant analgesics in patients with cancer is usually extrapolated from their efficacy in nononcological neuropathic pain syndromes.
In this systematic review, we sought to evaluate the evidence for the beneficial and adverse effects of pharmacologic treatment of neuropathic cancer pain.
A systematic review of the literature in PubMed and Embase was performed. Primary outcome measures were absolute risk benefit (ARB), defined as the number of patients with a defined degree of pain relief divided by the total number of patients in the treatment group, and absolute risk harm (ARH), defined as the fraction of patients who dropped out as a result of adverse effects.
We identified 30 articles that fulfilled our inclusion criteria. Overall, ARB of antidepressants, anticonvulsants, other adjuvant analgesics, or opioids greatly outweighed ARH. There were no significant differences in ARB or ARH between the four groups of medication or between patients with mixed vs. purely neuropathic pain. Because of the low methodological quality of the studies, we could not draw conclusions about the true treatment effect size of the four groups of medications.
Once a diagnosis of neuropathic pain has been established in patients with cancer, antidepressants, anticonvulsants, or other adjuvant analgesics should be considered in addition to or instead of opioids.
据估计，癌症疼痛患者中神经性疼痛的患病率约为 40%。神经性疼痛可能由肿瘤侵袭引起，被认为是混合性伤害感受神经性疼痛，也可能由抗癌治疗引起，被认为是纯粹的神经性疼痛。在癌症患者中使用辅助镇痛药通常是从它们在非肿瘤神经性疼痛综合征中的疗效外推而来的。
在本次系统评价中，我们旨在评估药物治疗神经性癌症疼痛的疗效和不良反应的证据。
对 PubMed 和 Embase 中的文献进行了系统评价。主要结局指标是绝对风险获益（ARB），定义为疼痛缓解程度定义的患者人数除以治疗组的总人数；绝对风险危害（ARH），定义为因不良反应而退出的患者比例。
我们确定了 30 篇符合纳入标准的文章。总的来说，抗抑郁药、抗惊厥药、其他辅助镇痛药或阿片类药物的 ARB 大大超过了 ARH。四组药物之间或混合性与纯粹神经性疼痛患者之间的 ARB 或 ARH 均无显著差异。由于研究的方法学质量较低，我们无法得出关于这四组药物的真实治疗效果大小的结论。
一旦确诊癌症患者存在神经性疼痛，除了阿片类药物之外，还应考虑使用抗抑郁药、抗惊厥药或其他辅助镇痛药。
