Zilliox Lindsay A
Continuum (Minneap Minn). 2017 Apr;23(2, Selected Topics in Outpatient Neurology):512-532. doi: 10.1212/CON.0000000000000462.
Neuropathic pain is a frequently encountered condition that is often resistant to treatment and is associated with poor patient satisfaction of their treatment. Several medications have been shown to be effective in treating neuropathic pain associated with diabetic neuropathy and postherpetic neuralgia, and these medications are often used to treat neuropathic pain associated with other conditions as well. This article summarizes the diagnosis and assessment of patients with neuropathic pain as well as available pharmacologic and interventional treatment options.
Evidence-based recommendations for the treatment of neuropathic pain have been published, and first-line medications include antidepressants, anticonvulsants, topical agents, as well as opioid analgesics. Interventional options include anesthetic and steroid injections, nerve blocks, and spinal cord stimulation. Essential to the treatment algorithm of neuropathic pain is the assessment and treatment of psychosocial comorbidities and the utilization of a multidisciplinary team approach, including cognitive-behavioral and rehabilitative therapies. Questions remain about the comparative effectiveness of various medications and combination therapies. Increasing interest also exists in the optimization and personalization of pharmacotherapy based upon the underlying mechanism(s) of neuropathic pain according to the quality of the patient's symptoms.
The management of chronic neuropathic pain is challenging and is best achieved with the use of a multidisciplinary team. Pain is a subjective experience, and it is important to validate a patient's pain, address psychosocial comorbidities, and set realistic treatment goals. Evidence-based guidelines are available to guide treatment, but frequently, high-quality evidence-based recommendations are lacking.
神经性疼痛是一种常见病症，常常难以治疗，且患者对治疗的满意度较低。已有多种药物被证明可有效治疗与糖尿病性神经病变及带状疱疹后神经痛相关的神经性疼痛，这些药物也常用于治疗与其他病症相关的神经性疼痛。本文总结了神经性疼痛患者的诊断与评估，以及现有的药物和介入治疗选择。
已发布了基于证据的神经性疼痛治疗推荐，一线药物包括抗抑郁药、抗惊厥药、局部用药以及阿片类镇痛药。介入治疗选择包括麻醉剂和类固醇注射、神经阻滞以及脊髓刺激。神经性疼痛治疗方案的关键在于评估和治疗心理社会共病，并采用多学科团队方法，包括认知行为疗法和康复治疗。关于各种药物和联合疗法的相对有效性仍存在疑问。根据患者症状的特点，基于神经性疼痛的潜在机制对药物治疗进行优化和个体化的兴趣也在增加。
慢性神经性疼痛的管理具有挑战性，最好通过多学科团队来实现。疼痛是一种主观体验，确认患者的疼痛、处理心理社会共病并设定现实的治疗目标非常重要。有基于证据的指南可指导治疗，但通常缺乏高质量的基于证据的推荐。
