Ahmadi Rezvan, Kuner Rohini, Weidner Norbert, Keßler Jens, Bendszus Martin, Krieg Sandro Manuel
Medical Faculty Heidelberg, Department of Neurosurgery, University Heidelberg, Heidelberg, Germany; Institute of Pharmacology, Heidelberg University, Heidelberg, Germany; Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany; Universität Heidelberg, Medizinische Fakultät Heidelberg, Klinik für Anästhesiologie; Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany; Consortium of the Collaborative Research Center 1158 of the German Research Foundation: From nociception to chronic pain.
Dtsch Arztebl Int. 2024 Dec 13;121(25):825-832. doi: 10.3238/arztebl.m2024.0215.
The reported prevalence of neuropathic pain in the general population in Germany is from 6.9% to 10%. There are both medical and surgical treatment options.
This review is based on pertinent publications retrieved by a selective search in PubMed, with consideration of clinical trials, meta-analyses, and guidelines.
Neuropathic pain is diagnosed when pain of the appropriate character is accompanied by further features such as hypesthesia/anesthesia, allodynia, or hyperalgesia. It is generally treated initially with drugs (antidepressant drugs, anticonvulsant drugs, opioids, topical agents, and others); the number needed to treat (NNT) is between 7 and 8 for gabapentin and 3.6 for amitryptiline, as estimated in meta-analyses. For nerve compression and entrapment syndromes, surgical decompression is a treatment directed against the cause of the problem, which can therefore be curative. Microvascular decompression (MVD) is often used to treat supposed compression syndromes of cranial nerves, above all classic trigeminal neuralgia; according to a meta-analysis, MVD brings about a pain-free state in 92.9% [89.1; 96.8] of patients after 5 months to 5 years of follow-up. Ablative surgical procedures are used for symptom control in patients with refractory and/or cancer-related pain. Further symptomdirected treatment options for medically intractable neuropathic pain include neuromodulatory techniques, which involve minimally invasive electrical stimulation of neural structures, and the chronic intrathecal application of drugs such as opioids and ziconotide.
The treatment of neuropathic pain can be either cause-directed or symptom-directed, depending on its origin. Multidisciplinary collaboration can facilitate both the diagnostic evaluation and the selection of the optional modality and timing of treatment.
据报道，德国普通人群中神经性疼痛的患病率为6.9%至10%。有药物和手术两种治疗选择。
本综述基于在PubMed中通过选择性检索获得的相关出版物，并参考了临床试验、荟萃分析和指南。
当具有适当特征的疼痛伴有诸如感觉减退/感觉缺失、痛觉过敏或痛觉超敏等其他特征时，可诊断为神经性疼痛。通常最初用药物治疗（抗抑郁药、抗惊厥药、阿片类药物、局部用药等）；荟萃分析估计，加巴喷丁的治疗所需人数（NNT）为7至8，阿米替林为3.6。对于神经受压和卡压综合征，手术减压是针对问题病因的治疗方法，因此可能具有治愈性。微血管减压术（MVD）常用于治疗所谓的颅神经受压综合征，尤其是典型的三叉神经痛；根据一项荟萃分析，在随访5个月至5年后，MVD使92.9%[89.1；96.8]的患者达到无痛状态。消融性外科手术用于难治性和/或癌症相关疼痛患者的症状控制。对于药物治疗难以控制的神经性疼痛，其他针对症状的治疗选择包括神经调节技术，即对神经结构进行微创电刺激，以及长期鞘内应用阿片类药物和齐考诺肽等药物。
神经性疼痛的治疗可以是针对病因的，也可以是针对症状的，这取决于其起源。多学科协作有助于诊断评估以及选择最佳治疗方式和治疗时机。
