Trouvin Anne-Priscille, Perrot Serge, Lloret-Linares Célia
Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Rheumatology A Department, Paris, France.
Assistance Publique-Hôpitaux de Paris Hôtel-Dieu and Cochin Hospital, Pain Center, INSERM U 987, Paris, France.
Clin Ther. 2017 Jun;39(6):1104-1122. doi: 10.1016/j.clinthera.2017.05.347. Epub 2017 May 26.
The prevalence of neuropathic pain is high in the general population, and high priority is given to the management of this pain condition. The treatment of neuropathic pain remains challenging, despite the publication of national and international recommendations. The purpose of this narrative review of venlafaxine (VLX) is to provide a better knowledge of the pharmacology of this drug and a clearer view of its efficacy and tolerability in neuropathic pain.
Two independent reviewers searched PubMed with the following search terms: serotonin and noradrenalin reuptake inhibitors OR VLX hydrochloride AND pain. The reviewers included all clinical studies that investigated VLX in neuropathic pain conditions and excluded animal studies, studies on fibromyalgia, studies that focused on the prevention of neuropathic pain, case reports, and studies that did not clearly describe neuropathic pain in the included patients. We describe the 13 studies that we analyzed.
Eleven were randomized clinical trials, and the comparator was placebo in 8 studies. Nine studies reported that VLX was effective against neuropathic pain. However, among the trials, only one against placebo included a large number of patients with >200 participants and one against prégabaline and carbamazepine had >200 patients. Most of the adverse events reported in the selected studies were consistent with known adverse events of VLX, and most were mild to moderate. However, most studies were of very short duration.
Most of the clinical studies found that VLX was effective and well tolerated. However, given the limited number of study and the limitations of all these studies, further large clinical trials are needed. Currently, considering the limited therapeutic options for treating neuropathic pain and the highly variable nature of responses to all drugs, VLX has a place as a treatment option for neuropathic pain.
神经病理性疼痛在普通人群中的患病率较高，对这种疼痛状况的管理受到高度重视。尽管已发布了国内和国际指南，但神经病理性疼痛的治疗仍然具有挑战性。本叙述性综述文拉法辛（VLX）的目的是更好地了解该药物的药理学，并更清楚地了解其在神经病理性疼痛中的疗效和耐受性。
两名独立审阅者使用以下检索词在PubMed中进行检索：5-羟色胺和去甲肾上腺素再摄取抑制剂或盐酸文拉法辛与疼痛。审阅者纳入了所有在神经病理性疼痛状况下研究文拉法辛的临床研究，并排除了动物研究、纤维肌痛研究、专注于预防神经病理性疼痛的研究、病例报告以及未明确描述纳入患者神经病理性疼痛的研究。我们描述了我们分析的13项研究。
11项为随机临床试验，8项研究中的对照为安慰剂。9项研究报告文拉法辛对神经病理性疼痛有效。然而，在这些试验中，只有一项针对安慰剂的试验纳入了大量（>200名）患者，一项针对普瑞巴林和卡马西平的试验有>200名患者。所选研究中报告的大多数不良事件与文拉法辛已知的不良事件一致，且大多数为轻度至中度。然而，大多数研究的持续时间非常短。
大多数临床研究发现文拉法辛有效且耐受性良好。然而，鉴于研究数量有限以及所有这些研究的局限性，需要进一步开展大型临床试验。目前，考虑到治疗神经病理性疼痛的治疗选择有限以及对所有药物反应的高度变异性，文拉法辛作为神经病理性疼痛的一种治疗选择具有一席之地。
