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首页> 外文期刊>Advanced studies in medicine >Pharmacotherapy for neuropathic pain: The old and the new
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Pharmacotherapy for neuropathic pain: The old and the new

机译：神经性疼痛的药物治疗：新与旧

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PURPOSE: To review the use of pharmacotherapy for the treatment of neuropathic pain, with a special emphasis on anticonvulsant medications. EPIDEMIOLOGY: By conservative estimates, between 0.6% and 1.5% of the US population suffers from conditions leading to neuropathic pain. Most commonly, nearly 6 million individuals seek treatment for pain related to diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN), although the list of underlying etiologies for this type of pain includes a myriad of conditions ranging from infectious diseases to musculoskeletal causes. REVIEW SUMMARY: The pathophysiology of neuropathic pain and select mechanisms of action and pharmacologic targets for analgesia are discussed. At present, a complete understanding of the precise pathophysiology for this type of pain and the mechanisms of actions for many of these therapeutic agents is lacking; however, several research-based theories are presented. US Food and Drug Administration (FDA)-approved, first-line and second-line medication regimens, including several classes of medications, are reviewed, focusing on anticonvulsant medications and new related agents, such as pregabalin. Specifically, recommendations issued by the Fourth International Conference on the Mechanisms and Treatment of Neuropathic Pain are discussed. Recommendations are based on the results of multiple, randomized clinical trials, published studies, and the clinical experience of the conference faculty. The 2 types of neuropathic pain emphasized in this article are PHN and DPN. Our understanding of pain mechanisms relate primarily to animal nerve injury models rather than these 2 conditions. The fact that PHN and DPN are primarily used for pharmacologic studies is related to: lack of other better uniform clinical models, and confounding psychosocial factors often seen in other less-defined clinical problems as complex regional pain syndrome or low-back pain. TYPE OF AVAILABLE EVIDENCE: In all examples of recommendations below, randomized, placebo-controlled trials are used. Much of the information comes from the Annals of Neurology 2003, which is the result of an international expert panel using all available evidence for their conclusions on neuropathic pain. All trial data are cited whenever recommendations are made. GRADE OF AVAILABLE EVIDENCE: Fair CONCLUSION: A variety of pharmacologic agents from classes including anticonvulsants, antidepressants, and opioids, among others, are available for the management of neuropathic pain-a condition for which our understanding is still in its infancy despite the fact that it afflicts millions of individuals who suffer from diabetes and other chronic illnesses. Decisions regarding which medication to use for management of neuropathic pain may come down to a number of practical considerations. These may include which drugs have US FDA approval; evidence of efficacy and safety from randomized, controlled trials; cost or formulary limitations; and personal experience. In the end, rational polypharmacy-using combinations of multiple medications with different mechanisms of action-may be the most effective means of gaining relief for particularly challenging patients. In the future, research may focus on developing a more complete understanding of neuropathic pain, with the goal of targeting therapies to modulate pain at its source within the nervous system.
机译：目的：回顾药物疗法在治疗神经性疼痛中的应用，特别强调抗惊厥药物。流行病学：据保守估计，美国人口中有0.6％至1.5％患有导致神经性疼痛的疾病。最常见的是，将近600万人寻求与糖尿病周围神经病变（DPN）和疱疹后神经痛（PHN）相关的疼痛的治疗方法，尽管针对这种类型疼痛的潜在病因包括从传染病到肌肉骨骼疾病的多种疾病。综述：讨论了神经性疼痛的病理生理学，作用的选择机制以及镇痛的药理目标。目前，对于这种类型的疼痛的确切病理生理学以及许多治疗剂的作用机理尚缺乏完整的理解。然而，提出了几种基于研究的理论。审查了美国食品和药物管理局（FDA）批准的一线和二线药物治疗方案，包括几类药物，重点关注抗惊厥药物和新的相关药物，如普瑞巴林。具体而言，讨论了第四次神经性疼痛的机制和治疗国际会议发布的建议。建议基于多项随机临床试验，已发表的研究结果以及会议教师的临床经验得出的结果。本文强调的两种神经性疼痛是PHN和DPN。我们对疼痛机制的理解主要与动物神经损伤模型有关，而不是与这两种情况有关。 PHN和DPN主要用于药理研究的事实与以下事实有关：缺乏其他更好的统一临床模型，以及在其他较不确定的临床问题中常见的复杂的社会心理因素，如复杂的区域性疼痛综合征或下背痛。可用证据的类型：在以下所有建议示例中，均使用随机，安慰剂对照试验。许多信息来自《神经病学年鉴2003》，这是一个国际专家小组使用所有可用证据得出的有关神经性疼痛的结论的结果。凡提出建议，均引用所有试验数据。可用证据的程度：合理的结论：包括抗惊厥药，抗抑郁药和阿片类药物在内的各种药物都可用于神经性疼痛的治疗，尽管事实上，它折磨着数百万患有糖尿病和其他慢性疾病的人。关于使用哪种药物治疗神经性疼痛的决定可能取决于许多实际考虑。这些可能包括哪些药物获得了美国FDA的批准;随机对照试验的有效性和安全性证据;成本或配方限制;和个人经验。最后，合理的多元药物疗法-结合多种具有不同作用机理的药物-可能是最有效的方法，可以缓解特别具有挑战性的患者。将来，研究可能集中在对神经性疼痛的更全面理解上，其目标是针对疗法来调节神经系统内疼痛的来源。

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