Περίληψη:
Neuropathic pain is defined as pain caused by a lesion in the nervous system and is common in clinical practice. Diagnosis can be difficult. Recommendations for first-line pharmacologic treatments are based on positive results from multiple, randomized, controlled trials, and recommendations for second-line pharmacologic treatments are based on the positive result of a single, randomized, controlled trial or inconsistent results of multiple, randomized, controlled trials. The results of published trials and clinical experience provide the foundation for specific recommendations for first-line treatments, which include gabapentin, 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants (TCAs). Gabapentin (up to 3,600 mg/day) significantly reduced pain compared with placebo; improvements in sleep, mood, and quality of life were also demonstrated. Adverse effects of gababentin include somnolence and dizziness, and, less commonly, gastrointestinal symptoms and mild peripheral edema. Thus, monitoring and dosage adjustment are required, without discontinuation of the drug. Gabapentin combined with morphine achieved better analgesia at lower doses of each drug than each drug alone, with only mild adverse effects. The first medication that proved effective for neuropathic pain in placebo-controlled trials was TCAs. Treatment decisions for patients with neuropathic pain can be difficult. Interest in the mechanisms and treatment of chronic neuropathic pain has increased during the past years, resulting in significant treatment advances in the future. In this article all recent knowledge on therapeutic management of chronic neuropathic pain is presented. © 2006 New York Academy of Sciences.
Συγγραφείς:
Vadalouca, A.
Siafaka, I.
Argyra, E.
Vrachnou, E.
Moka, E.
Λέξεις-κλειδιά:
4 aminobutyric acid B receptor stimulating agent; acetylsalicylic acid; amfebutamone; amitriptyline; carbamazepine; corticosteroid; duloxetine; gabapentin; ibuprofen; imipramine; lamotrigine; levorphanol; lidocaine; methadone; mexiletine; morphine; nortriptyline; opiate; oxcarbazepine; oxycodone; paracetamol; phenytoin; pregabalin; tiagabine; topiramate; tramadol; tricyclic antidepressant agent; unindexed drug; valproic acid; venlafaxine; 4 aminobutyric acid; amine; analgesic agent; cyclohexanecarboxylic acid derivative; gabapentin; tricyclic antidepressant agent, agitation; analgesia; cancer patient; clinical practice; clinical trial; cognitive defect; comparative study; complex regional pain syndrome; conference paper; constipation; diabetic neuropathy; dizziness; drug dose titration; drug efficacy; drug induced headache; drug megadose; drug monitoring; drug tolerance; electromyography; electroneurography; erythema; evoked somatosensory response; functional magnetic resonance imaging; gastrointestinal symptom; human; insomnia; laser surgery; low drug dose; nausea; nerve injury; neuralgia; neuropathic pain; orthostatic hypotension; peripheral edema; population; positron emission tomography; prevalence; quality of life; rash; sedation; sensory neuropathy; sexual dysfunction; side effect; somnolence; trigeminus neuralgia; weight gain; xerostomia; chronic disease; neuralgia; review, Amines; Analgesics; Antidepressive Agents, Tricyclic; Chronic Disease; Cyclohexanecarboxylic Acids; gamma-Aminobutyric Acid; Humans; Neuralgia
