Division of Population Health Sciences, Ninewells Hospital & Medical School, University of Dundee, Dundee DD2 4DB, UK.
Br J Anaesth. 2013 Jul;111(1):73-9. doi: 10.1093/bja/aet206.
Neuropathic pain is a common chronic pain condition that can be challenging to treat, particularly for non-specialists. The development of the Map of Medicine care pathway for the management of neuropathic pain was led by the British Pain Society. Focusing on treatment by non-specialists, this pathway is based on new evidence, consensus, and the interests of service users. This paper presents the care pathway and accompanying evidence base, highlighting its salient features, and discussing important treatment points. After initial assessment, the pathway progresses through first-, second-, and third-line drug treatment, includes advice on topical treatment and opioids (in specific circumstances), and describes non-pharmacological approaches. Importantly, timely review of patients and referral to specialist secondary or tertiary care must be considered as vital components of the pathway. Although the emphasis was not on specialist treatment, advice is given on existing interventions, including neural stimulation and multi-disciplinary care. These, and other steps on the pathway, will be subject to further review as more evidence becomes available. In the meantime, the pathway represents a straightforward, valuable and accessible approach for healthcare professionals managing the distress and impact of neuropathic pain.
神经病理性疼痛是一种常见的慢性疼痛病症,治疗起来具有挑战性,特别是对非专家而言。英国疼痛学会牵头制定了医学地图管理神经病理性疼痛的治疗路径。该路径侧重于非专家的治疗,基于新证据、共识和服务使用者的利益。本文介绍了治疗路径及其配套的证据基础,强调了其显著特征,并讨论了重要的治疗要点。初始评估后,该路径通过一线、二线和三线药物治疗推进,包括局部治疗和阿片类药物(在特定情况下)的建议,并描述了非药物治疗方法。重要的是,必须考虑及时审查患者并将其转介到专家二级或三级护理,这是该路径的重要组成部分。尽管重点不是专家治疗,但针对现有的干预措施,包括神经刺激和多学科护理,也提供了相关建议。随着更多证据的出现,这些以及路径上的其他步骤将进行进一步审查。在此期间,该路径为管理神经病理性疼痛的痛苦和影响的医疗保健专业人员提供了一种简单、有价值且易于使用的方法。