Huygen Frank, Kern Kai-Uwe, Pérez Concepción
Department of Anesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Institute for Pain Medicine/Pain Practice Wiesbaden, Wiesbaden, Germany.
J Pain Res. 2020 Oct 14;13:2585-2597. doi: 10.2147/JPR.S263054. eCollection 2020.
Treatment of peripheral neuropathic pain (PNP) remains a challenge. In the absence of clear predictors of response, clinical decision-making involves trial and error. While many classes of pharmacological agent are used and have shown efficacy, one of the most commonly used first-line treatments is pregabalin. However, in the 60% of PNP cases in which the pain is localized, a local treatment may be more suitable. This article will summarize the evidence for the relative effectiveness and tolerability of the capsaicin 179 mg patch and pregabalin in the treatment of PNP and highlight the expert opinion of the authors based on their own clinical experiences.
When compared in a head-to-head trial in patients with PNP, capsaicin 179 mg patch provided non-inferior pain relief compared with an optimized dose of pregabalin, as well as a reduction in dynamic mechanical allodynia, faster onset of action, fewer systemic side effects, and greater treatment satisfaction. Adverse events associated with capsaicin patch are mainly application site reactions, compared with systemic and central nervous system effects with pregabalin. Studies indicate that capsaicin 179 mg patch is associated with a lower burden of therapy than pregabalin in terms of improved tolerability, lack of a daily pill burden, lack of drug-drug interactions, and increased regimen flexibility.
In localized neuropathic pain, evidence supports a pragmatic approach of using a local treatment before considering a systemic treatment. For treatment selection, the patient profile (eg, concomitant medication use, age) and the treatments' efficacy and tolerability profiles should be considered.
外周神经性疼痛（PNP）的治疗仍然是一项挑战。在缺乏明确的反应预测指标的情况下，临床决策需要反复试验。虽然使用了多种类别的药物且已显示出疗效，但最常用的一线治疗药物之一是普瑞巴林。然而，在60%疼痛局限的PNP病例中，局部治疗可能更为合适。本文将总结辣椒素179mg贴剂和普瑞巴林在治疗PNP方面相对有效性和耐受性的证据，并根据作者自身的临床经验突出他们的专家意见。
在PNP患者的头对头试验中进行比较时，辣椒素179mg贴剂与优化剂量的普瑞巴林相比，提供了非劣效的疼痛缓解，同时还减少了动态机械性异常性疼痛，起效更快，全身副作用更少，治疗满意度更高。与辣椒素贴剂相关的不良事件主要是应用部位反应，而普瑞巴林则有全身和中枢神经系统效应。研究表明，在耐受性改善、无每日服药负担、无药物相互作用以及治疗方案灵活性增加方面，辣椒素179mg贴剂的治疗负担低于普瑞巴林。
在局限性神经性疼痛中，有证据支持在考虑全身治疗之前先采用局部治疗的务实方法。在选择治疗方法时，应考虑患者情况（如同时使用的药物、年龄）以及治疗方法的疗效和耐受性情况。
