Departments of Anaesthesiology and Perioperative Medicine and Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
Lancet Neurol. 2013 Nov;12(11):1084-95. doi: 10.1016/S1474-4422(13)70193-5. Epub 2013 Sep 25.
Chronic pain, a frequently neglected problem, is treated with different classes of drugs. Current agents are limited by incomplete efficacy and dose-limiting side-effects. Knowledge of pain processing implicates multiple concurrent mechanisms of nociceptive transmission and modulation. Thus, synergistic interactions of drug combinations might provide superior analgesia and fewer side-effects than monotherapy by targeting of multiple mechanisms. Several trials in neuropathic pain, fibromyalgia, arthritis, and other disorders have assessed various two-drug combinations containing antidepressants, anticonvulsants, non-steroidal anti-inflammatories, opioids, and other agents. In some trials, combined treatment showed superiority over monotherapy, but in others improved benefit or tolerability was not seen. Escalating efforts to develop novel analgesics that surpass the efficacy of current treatments have not yet been successful; therefore, combination therapy remains an important beneficial strategy. Methodological improvements in future translational research efforts are needed to maximise the potential of combination pharmacotherapy for pain.
慢性疼痛是一个经常被忽视的问题，通常采用不同类别的药物进行治疗。目前的治疗药物疗效有限，且存在剂量限制的副作用。对疼痛处理的认识提示存在多种并发的伤害性传递和调制机制。因此，通过针对多种机制的药物联合治疗，可能比单一疗法提供更好的镇痛效果和更少的副作用。在神经病理性疼痛、纤维肌痛、关节炎和其他疾病的几项试验中，评估了包含抗抑郁药、抗惊厥药、非甾体抗炎药、阿片类药物和其他药物的各种二联药物组合。在一些试验中，联合治疗显示优于单一疗法，但在其他试验中，改善益处或耐受性并未出现。尽管开发超越现有治疗效果的新型镇痛药的努力不断增加，但尚未取得成功；因此，联合治疗仍然是一种重要的有益策略。需要在未来的转化研究工作中进行方法学改进，以最大限度地发挥联合药物治疗疼痛的潜力。
