Department of Neurosurgery, Translational Pain Research Program, University of Rochester, 2180 South Clinton Avenue, Rochester, NY, USA.
Division of Neurological Pain Research and Therapy, Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Haus 41, Arnold-Heller-Strasse 3, 24105 Kiel, Germany.
Drug Discov Today. 2018 Nov;23(11):1904-1909. doi: 10.1016/j.drudis.2018.06.004. Epub 2018 Jun 9.
This review examines the stark contrast between the successes and failures of the clinical development of analgesics for different types of chronic low back pain (CLBP) syndrome over the past three decades. Multiple drugs with differing mechanisms of action have been developed for nonspecific axial-predominant low back syndromes and yet not a single therapy is indicated for any neuropathic low back pain syndrome (e.g., sciatica). Clinician findings have informed the entry criteria for neuropathic low back pain clinical trials, whereas entry criteria of axial CLBP trials have prioritized only patient reports of pain. This key difference could account for the lack of success in developing therapies for neuropathic low back pain in an era marked by successful development of analgesics for other types of CLBP as well as many chronic pain syndromes associated with nerve injury, such as post-herpetic neuralgia (PHN).
这篇综述考察了过去三十年中，不同类型慢性下背痛（CLBP）综合征的镇痛药临床开发的成败对比。已经开发出了多种具有不同作用机制的药物来治疗非特异性轴向为主的低背综合征，但没有一种疗法适用于任何神经病理性低背痛综合征（例如坐骨神经痛）。临床医生的发现为神经病理性低背痛临床试验的纳入标准提供了信息，而轴向 CLBP 试验的纳入标准则仅优先考虑患者的疼痛报告。这一关键差异可能导致在神经病理性低背痛治疗方面的开发缺乏成功，而在其他类型的 CLBP 以及许多与神经损伤相关的慢性疼痛综合征（如疱疹后神经痛（PHN））的镇痛药开发方面取得了成功。
