Pickering Gisèle, Martin Elodie, Tiberghien Florence, Delorme Claire, Mick Gérard
Centre de Pharmacologie Clinique, CHU Clermont-Ferrand.
Inserm, CIC 1405, Neurodol 1107.
Drug Des Devel Ther. 2017 Sep 13;11:2709-2718. doi: 10.2147/DDDT.S142630. eCollection 2017.
Pain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments.
Literature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice.
Successive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously.
Although there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug-drug interactions.
疼痛定位是神经性疼痛一线治疗选择的标志之一。进行本综述旨在概述有关局限性神经性疼痛（LNP）的病因和病理生理学、其评估以及现有的局部药物治疗的当前知识。
使用Medline对2010年至2016年12月的文献进行综述，并审查所有涉及LNP和治疗的研究。本文由五名疼痛专家组成的多学科专家小组报告了关于可能推荐用于缓解LNP的局部方法及其在临床实践中的优势的共识。
国际上相继推荐使用5%利多卡因和8%辣椒素局部治疗LNP。专家小组认为，这些化合物可作为LNP的一线治疗药物，尤其是老年患者以及患有合并症和多种药物治疗的患者。LNP的监管适应症应涵盖LNP的整个范围，而不仅限于特定病因或部位。必须谨慎遵循使用贴剂的注意事项。
尽管这两种药物确实都需要更多的随机对照试验，但出版物清楚地表明，在长期治疗中，它们具有出色的风险/效益比、安全性、耐受性和持续疗效。两种贴剂的一个主要优点是它们已被证明有效，并且可能降低与全身性神经性疼痛治疗相关的不良事件风险，如认知障碍、意识模糊、嗜睡、头晕和便秘，这些不良事件会降低生活质量。局部治疗方式也可与其他药物和镇痛药联合使用，药物相互作用有限。
