Attal Nadine
Inserm U987, centre d'évaluation et de traitement de la douleur, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France.
Rev Prat. 2013 Jun;63(6):795-802.
Neuropathic pain is difficult to treat. First line treatment includes tricyclic antidepressants (notably amitriptyline), mixed serotonin and norepinephrine reuptake inhibitors (duloxetine for diabetic peripheral neuropathic pain), antiepileptics (gabapentin and pregabalin) and topical agents (lidocaine plasters for postherpetic neuralgia). These drugs can be subsequently associated in case of partial response to monotherapy. Opioids and tramadol are only considered second/third line, alone or in combination with first line drugs.
神经性疼痛难以治疗。一线治疗包括三环类抗抑郁药（尤其是阿米替林）、5-羟色胺和去甲肾上腺素再摄取抑制剂（度洛西汀用于治疗糖尿病性周围神经病变疼痛）、抗癫痫药（加巴喷丁和普瑞巴林）以及局部用药（利多卡因贴剂用于治疗带状疱疹后神经痛）。如果单一疗法仅产生部分疗效，这些药物随后可以联合使用。阿片类药物和曲马多仅被视为二线/三线药物，可单独使用或与一线药物联合使用。
