Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France.
Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France; Department of Psychiatry and Neuroscience, Université Laval, Québec, QC G1V 0A6, Canada.
Pharmacol Ther. 2023 Nov;251:108546. doi: 10.1016/j.pharmthera.2023.108546. Epub 2023 Oct 11.
Neuropathic pain, caused by a lesion or disease affecting the somatosensory system, affects between 3 and 17% of the general population. The treatment of neuropathic pain is challenging due to its heterogeneous etiologies, lack of objective diagnostic tools and resistance to classical analgesic drugs. First-line treatments recommended by the Special Interest Group on Neuropathic Pain (NeuPSIG) and European Federation of Neurological Societies (EFNS) include gabapentinoids, tricyclic antidepressants (TCAs) and selective serotonin noradrenaline reuptake inhibitors (SNRIs). Nevertheless these treatments have modest efficacy or dose limiting side effects. There is therefore a growing number of preclinical and clinical studies aim at developing new treatment strategies to treat neuropathic pain with better efficacy, selectivity, and less side effects. In this review, after a brief description of the mechanisms of action, efficacy, and limitations of current therapeutic drugs, we reviewed new preclinical and clinical targets currently under investigation, as well as promising non-pharmacological alternatives and their potential co-use with pharmacological treatments.
神经病理性疼痛是由躯体感觉系统的损伤或疾病引起的，影响着全球 3%至 17%的人群。由于其病因异质性、缺乏客观诊断工具以及对经典镇痛药物的耐药性，神经病理性疼痛的治疗极具挑战性。神经病理性疼痛特别兴趣小组（NeuPSIG）和欧洲神经病学学会联合会（EFNS）推荐的一线治疗方法包括加巴喷丁类药物、三环类抗抑郁药（TCAs）和选择性 5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）。然而，这些治疗方法的疗效有限，且存在剂量限制的副作用。因此，越来越多的临床前和临床研究旨在开发新的治疗策略，以提高疗效、选择性并减少副作用来治疗神经病理性疼痛。在这篇综述中，我们简要描述了当前治疗药物的作用机制、疗效和局限性，然后回顾了目前正在研究的新的临床前和临床靶点，以及有前途的非药物替代疗法及其与药物治疗的潜在联合应用。
