Kiss Gábor
Ideggyogy Sz. 2015 Mar 30;68(3-4):93-8.
Neuropathic pain is considered as a special type of different pain conditions. It's pathophysiological basis and treatment is completely different from the nociceptive pain. The first comprehensive therapeutic guidelines published approximately a decade ago recommended tricyclic antidepressants, anticonvulsants and opioids. The recent summary presents and evaluates national and international guidelines issued in the last five years. The most frequently suggested drugs by all guidelines are amitriptyline, duloxetine, gabapentin and pregabalin. Pregabalin is the only drug that is recommended first line in all guidelines referred. Opioids are in the second or third line. There seems to be no major development in the pharmacological treatment of the neuropathic pain compared to the earlier recommendations. High quality studies of head to head comparisons and effectiveness of combination therapy are still lacking.
神经病理性疼痛被认为是一种特殊类型的不同疼痛状况。其病理生理基础和治疗方法与伤害性疼痛完全不同。大约十年前发布的首个综合治疗指南推荐使用三环类抗抑郁药、抗惊厥药和阿片类药物。近期的综述介绍并评估了过去五年发布的国内和国际指南。所有指南中最常推荐的药物是阿米替林、度洛西汀、加巴喷丁和普瑞巴林。普瑞巴林是所有被提及的指南中唯一被推荐为一线用药的药物。阿片类药物处于二线或三线。与早期建议相比,神经病理性疼痛的药物治疗似乎没有重大进展。仍然缺乏高质量的头对头比较研究和联合治疗有效性研究。