Binder Andreas, Baron Ralf
University Hospital Schleswig-Holstein, Kiel, Division of Neurological Pain Research and Therapy, Department of Neurology.
Dtsch Arztebl Int. 2016 Sep 16;113(37):616-625. doi: 10.3238/arztebl.2016.0616.
Chronic neuropathic pain, including painful peripheral polyneuropathy and post-herpetic neuralgia, affects 6.9-10% of the general population.
In this article, we present current treatment recommendations on the basis of a selective review of the literature.
Neuropathic pain does not respond consistently to classic non-opioid analgesic drugs and is better treated with co-analgesic, antidepressant, and anticonvulsant drugs and topical agents. Under certain conditions, however, neuropathic pain can be treated with opioids, even chronically. It was concluded in a large-scale m eta- analysis that tricyclic antidepressants, selective serotonin- norepinephrine reuptake inhibitors, and calcium-channel anticonvulsants are the drugs of first choice, with a number needed to treat (NNT) of 3.5-7.7 for a 50% reduction of pain. An analysis of all studies yielded an estimated publication bias of 10%. Treatment planning must include adequate consideration of the patient's age and comorbidities, concomitant medication, and potential side effects.
Drugs are now chosen to treat neuropathic pain independently of the cause and symptoms of the pain. Topical agents are used only to treat peripheral neuropathy. The utility of a treatment approach based on the patient's symptoms and pathological mechanisms was recently demonstrated for the first time in a randomized trial. The goal of current research is to facilitate treatment planning on the basis of the clinical phenotype.
慢性神经性疼痛，包括疼痛性外周多发性神经病和带状疱疹后神经痛，影响6.9%至10%的普通人群。
在本文中，我们在对文献进行选择性综述的基础上提出当前的治疗建议。
神经性疼痛对经典非阿片类镇痛药的反应并不一致，使用辅助镇痛药、抗抑郁药、抗惊厥药和局部用药治疗效果更好。然而，在某些情况下，神经性疼痛甚至可以长期用阿片类药物治疗。一项大规模荟萃分析得出结论，三环类抗抑郁药、选择性5-羟色胺-去甲肾上腺素再摄取抑制剂和钙通道抗惊厥药是首选药物，疼痛减轻50%时所需治疗人数（NNT）为3.5至7.7。对所有研究的分析得出估计的发表偏倚为10%。治疗计划必须充分考虑患者的年龄、合并症、同时使用的药物以及潜在的副作用。
现在选择药物治疗神经性疼痛时不考虑疼痛的病因和症状。局部用药仅用于治疗外周神经病。最近在一项随机试验中首次证明了基于患者症状和病理机制的治疗方法的实用性。当前研究的目标是促进基于临床表型的治疗计划。
