Schlereth Tanja
DKD Helios Hospital Wiesbaden, Aukammallee 33, 65191 Wiesbaden, Germany.
Neurol Res Pract. 2020 Jun 10;2:16. doi: 10.1186/s42466-020-00063-3. eCollection 2020.
2019 the DGN (Deutsche Gesellschaft für Neurology) published a new guideline on the diagnosis and non-interventional therapy of neuropathic pain of any etiology excluding trigeminal neuralgia and CRPS (complex regional pain syndrome). Neuropathic pain occurs after lesion or damage of the somatosensory system. Besides clinical examination several diagnostic procedures are recommended to assess the function of nociceptive A-delta and C-Fibers (skin biopsy, quantitative sensory testing, Laser-evoked potentials, Pain-evoked potentials, corneal confocal microscopy, axon reflex testing). First line treatment in neuropathic pain is pregabalin, gabapentin, duloxetine and amitriptyline. Second choice drugs are topical capsaicin and lidocaine, which can also be considered as primary treatment in focal neuropathic pain. Opioids are considered as third choice treatment. Botulinum toxin can be considered as a third choice drug for focal limited pain in specialized centers only. Carbamazepine and oxcarbazepine cannot be generally recommended, but might be helpful in single cases. In Germany, cannabinoids can be prescribed, but only after approval of reimbursement. However, the use is not recommended, and can only be considered as off-label therapy within a multimodal therapy concept.
2019年，德国神经病学学会（DGN）发布了一项关于除三叉神经痛和复杂性区域疼痛综合征（CRPS）外任何病因所致神经性疼痛的诊断及非介入性治疗的新指南。神经性疼痛发生于躯体感觉系统受损或遭破坏之后。除临床检查外，还推荐了几种诊断程序来评估伤害性Aδ纤维和C纤维的功能（皮肤活检、定量感觉测试、激光诱发电位、疼痛诱发电位、角膜共聚焦显微镜检查、轴突反射测试）。神经性疼痛的一线治疗药物为普瑞巴林、加巴喷丁、度洛西汀和阿米替林。二线药物为局部用辣椒素和利多卡因，在局灶性神经性疼痛中也可作为一线治疗药物。阿片类药物被视为三线治疗药物。仅在专业中心，肉毒杆菌毒素可被视为治疗局限性疼痛的三线药物。卡马西平和奥卡西平一般不推荐使用，但在个别情况下可能有用。在德国，大麻素类药物可以开具处方，但必须经过报销批准。然而，不推荐使用，仅在多模式治疗概念中可被视为超说明书用药治疗。
