Alcántara Montero A, Ibor Vidal P J, Alonso Verdugo A, Trillo Calvo E
Centro de Salud Manuel Encinas, Consultorio de Malpartida de Cáceres, Cáceres, España; Grupo de Trabajo de Dolor de SEMERGEN.
Centro de Salud Guillem de Castro, Valencia, España; Grupo de Trabajo de Dolor de SEMERGEN.
Semergen. 2019 Nov-Dec;45(8):535-545. doi: 10.1016/j.semerg.2019.05.008. Epub 2019 Jul 20.
We provide an updated review of the pharmacological treatment of neuropathic pain, with emphasis on the latest evidence-based recommendations. Drugs proposed as first line include tricyclic antidepressants (particularly amitriptyline), serotonin-noradrenaline reuptake inhibitors (particularly duloxetine), pregabalin and gabapentin. Second-line treatments include 5% lidocaine medicated plasters and capsaicin 8% patches, only for peripheral neuropathic pain and tramadol; whereas potent opioids and botulinum toxin A (for peripheral neuropathic pain) are considered third-line treatments. Future perspectives include the development of new drugs and a more personalised therapeutic approach, which is made possible by recent progress in the assessment and understanding of neuropathic pain.
我们提供了一份关于神经性疼痛药物治疗的最新综述，重点关注最新的循证医学建议。推荐作为一线治疗的药物包括三环类抗抑郁药（尤其是阿米替林）、5-羟色胺-去甲肾上腺素再摄取抑制剂（尤其是度洛西汀）、普瑞巴林和加巴喷丁。二线治疗包括仅用于外周神经性疼痛的5%利多卡因药用贴膏和8%辣椒素贴剂以及曲马多；而强效阿片类药物和肉毒杆菌毒素A（用于外周神经性疼痛）被视为三线治疗。未来的前景包括新药的研发以及更具个性化的治疗方法，这得益于近期在神经性疼痛评估和理解方面取得的进展而成为可能。
