Medicus, Vol. 23 No. 2. Liječenje boli, 2014.
Pregledni rad
Neuropathic Pain
Ante Barada
Sažetak
Neuropathic pain is an unpleasant sensory and emotional experience caused by a lesion or a disease of the somatosensory nervous system. It is estimated to affect as much as 7-8% of the general population in Europe. Classic examples include painful diabetic polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, and central poststroke and spinal cord injury pain, although traumatic/postsurgical neuropathies and painful radiculopathies represent common conditions in the general population. Neuropathic pain is a reflection of a pathologic event in the nervous system that results in a series of pathophysiological mechanisms involved in the onset of pain. It occurs spontaneously, particularly at rest, and is experienced as a burning, shooting or sharp stabbing pain. It is provoked by touch (mechanical allodynia) or temperature change (thermal allodynia). The pain interferes with sleep and provokes anxiety and depression, reducing a patient’squality of life. There are two goals in neuropathic pain treatment: firstly, establish a correct diagnosis and treat primary disease, and secondly, define painful syndrome and treat pain symptomatically. The EFNS guidelines for the treatment of neuropathic pain recommend the use of antiepileptic drugs (gabapentin, pregabalin), tricyclic antidepressants and SNRIs (duloxetine, venlafaxine) as drugs of first choice. Second-line treatment includes opioids. Topical lidocaine may be a drug of choice in patients with mechanical allodynia. Combined therapy can be used if monotherapy proves unsuccessful, and drugs with mutually supplementary mechanisms of action should be used. Transcutaneous electrical nerve stimulation (TENS) has a proven analgesic effect and, along with regular kinesitherapy, significantly contributes to the improvement of a patient’s functional state. Psychotherapeutic support is important in the treatment of chronic pain. Diagnostics and treatment of neuropathic pain require an interdisciplinary and multimodal approach.
Ključne riječi
neuropathic pain; allodynia; hyperalgesia; individual approach; multimodal treatment
Hrčak ID:
127309
URI
Datum izdavanja:
24.9.2014.
Posjeta: 9.192 *