Pain Clinic, Department of Anesthesia and Reanimation, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Spain.
Pain Clinic, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain.
Medicina (Kaunas). 2022 Apr 30;58(5):627. doi: 10.3390/medicina58050627.
Interventional management of neuropathic pain (NP) is available to the patients who do not obtain satisfactory pain relief with pharmacotherapy. Evidence supporting this is sparse and fragmented. We attempted to summarize and critically appraise the existing data to identify strategies that yield the greatest benefit, guide clinicians, and identify areas that merit further investigation. A two-round Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 26-item questionnaire made by the authors. Consensus on each statement was defined as either at least 80% endorsement or rejection after the 2nd round. Thirty-five and 29 panelists participated in the 1st and 2nd round, respectively. Consensus was reached in 20 out of 26 statements. There is sufficient basis to treat postherpetic neuralgias and complex regional pain syndromes with progressive levels of invasiveness and failed back surgery syndrome with neuromodulation. Radiculopathies and localized NP can be treated with peripheral blocks, neuromodulation, or pulsed radiofrequency. Non-ablative radiofrequency and non-paresthetic neuromodulation are efficacious and better tolerated than ablative and suprathreshold procedures. A graded approach, from least to most invasive interventions has the potential to improve outcomes in many patients with common refractory NP conditions. Preliminary promising data warrant further research on new indications, and technical advances might enhance the safety and efficacy of current and future therapies.
神经病理性疼痛（NP）的介入治疗适用于那些药物治疗未能获得满意缓解的患者。支持这一观点的证据很少且零散。我们试图总结和批判性地评估现有数据，以确定获益最大的策略，指导临床医生，并确定值得进一步研究的领域。我们进行了两轮德尔菲调查，涉及具有 NP 研究和管理经验的疼痛诊所专家，该调查基于作者制作的 26 项特别问卷。第二轮后，至少 80%的专家表示同意或反对，则定义为对每个声明达成共识。分别有 35 名和 29 名专家参加了第一轮和第二轮调查。在 26 项声明中有 20 项达成了共识。有充分的依据可以使用渐进性侵入性水平治疗带状疱疹后神经痛和复杂性区域疼痛综合征，以及使用神经调节治疗失败的腰椎手术综合征。神经根病和局部 NP 可以使用外周阻滞、神经调节或脉冲射频治疗。非消融性射频和非感觉神经调节比消融性和阈上性手术更有效且更耐受。从最小侵入性干预到最大侵入性干预的分级方法有可能改善许多常见难治性 NP 患者的预后。初步有前途的结果数据支持对新适应症进行进一步研究，并且技术进步可能会提高当前和未来治疗的安全性和有效性。
