Galer B S
Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA.
Neurology. 1995 Dec;45(12 Suppl 9):S17-25; discussion S35-6. doi: 10.1212/wnl.45.12_suppl_9.s17.
A variety of mechanisms may generate pain resulting from injury to the peripheral nervous system. None of these mechanisms is disease-specific, and several different pain mechanisms may be simultaneously present in any one patient, independent of diagnosis. Diagnosis of neuropathic pain is often easily made from information gathered on neurologic examination and from patient history. Evidence of sensory disturbances elicited on examination combined with laboratory tests confirming injury to peripheral nerve establishes the diagnosis of neuropathic pain. Although treatment of neuropathic pain may be difficult, optimum treatment can be achieved if the neurologist has a complete understanding of the therapeutic options, the mainstay of which is pharmacotherapy. Selection of an appropriate pharmacologic agent is by trial and error since individual responses to different agents, doses, and serum levels are highly variable. An adequate trial for each agent tried is key to pharmacologic treatment of neuropathic pain. Tricyclic antidepressants are first-line agents, although other drugs, including anticonvulsants, local anesthetic antiarrhythmics, clonidine, opioids, and certain topical agents, also offer pain relief in some patient populations. The novel antidepressants venlafaxine and nefazodone are potentially useful new drugs that are better tolerated than tricyclic antidepressants.
多种机制可导致因外周神经系统损伤而产生疼痛。这些机制均非疾病特异性的，且在任何一位患者身上，几种不同的疼痛机制可能同时存在，与诊断无关。神经性疼痛的诊断通常可根据神经科检查收集的信息以及患者病史轻松做出。检查时引出的感觉障碍证据，再加上实验室检查证实外周神经损伤，即可确立神经性疼痛的诊断。虽然神经性疼痛的治疗可能困难，但如果神经科医生对治疗选择有全面的了解，其中主要是药物治疗，就能够实现最佳治疗效果。由于个体对不同药物、剂量和血清水平的反应差异很大，因此选择合适的药物需通过反复试验。对每种试用药物进行充分的试验是神经性疼痛药物治疗的关键。三环类抗抑郁药是一线药物，不过其他药物，包括抗惊厥药、局部麻醉抗心律失常药、可乐定、阿片类药物以及某些局部用药，在一些患者群体中也能缓解疼痛。新型抗抑郁药文拉法辛和奈法唑酮是潜在有用的新药，耐受性比三环类抗抑郁药更好。
