背景:疼痛定位是选择神经性疼痛一线治疗的标志之一。本文献综述旨在概述有关局部神经性疼痛(LNP)的病因和病理生理学的当前知识。其评估和现有的局部药物治疗。
方法:使用Medline从2010年至2016年12月进行文献综述,并检查了所有涉及LNP和治疗的研究。由五名疼痛专家组成的多学科专家小组在本文中报告了关于可能建议缓解LNP的局部方法及其在临床实践中的优势的共识。
结果:连续的国际建议包括局部使用5%利多卡因和8%辣椒素治疗LNP。专家小组认为,这些化合物可以作为LNP的一线治疗,特别是在老年患者和有合并症和多重用药的患者中。调节性LNP适应症应涵盖LNP的整个范围,而不限于特定病因或部位。使用膏药的注意事项必须谨慎。
结论:尽管这两种药物确实需要更多的随机对照试验,出版物清楚地表明了优异的风险/效益比,安全,在整个长期治疗中的耐受性和持续疗效。这两种膏药的主要优点是它们已经证明了疗效,并且可以降低不良事件的风险,例如认知障碍,混乱,嗜睡,头晕和便秘常与全身神经性疼痛治疗相关,降低生活质量。局部治疗方式也可以与其他药物和止痛药联合使用,药物-药物相互作用有限。
BACKGROUND: Pain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of
localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments.
METHODS: Literature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a
consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice.
RESULTS: Successive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously.
CONCLUSIONS: Although there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug-drug interactions.