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Pharmacotherapy in Neuropathic Pains: Evidence-Based Approach

만성 신경병성 통증의 약물 치료: 근거-중심의 약물 치료

  • Cho, Sang-Hoon (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Ahn, Yong-Woo (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Ok, Soo-Min (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Huh, Joon-Young (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Ko, Myung-Yun (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Jeong, Sung-Hee (Department of Oral Medicine, School of Dentistry, Pusan National University)
  • 조상훈 (부산대학교 치의학전문대학원 구강내과학 교실) ;
  • 안용우 (부산대학교 치의학전문대학원 구강내과학 교실) ;
  • 옥수민 (부산대학교 치의학전문대학원 구강내과학 교실) ;
  • 허준영 (부산대학교 치의학전문대학원 구강내과학 교실) ;
  • 고명연 (부산대학교 치의학전문대학원 구강내과학 교실) ;
  • 정성희 (부산대학교 치의학전문대학원 구강내과학 교실)
  • Received : 2011.02.08
  • Accepted : 2011.03.25
  • Published : 2011.06.30

Abstract

Neuropathic pain is defined by "pain is initiated or caused by primary lesion or dysfunction in the nervous system" and several etiologic conditions can induce the neuropathic pains. Various groups of drugs are used to treat the neuropathic pains. Not depending on anecdotal case or habitual choice, to obtain the more effective pharmacotherapy, relative-comparison index is suggested through multiple analyses of clinical trials. Depending on relative-comparison index, first-line medications and second-line medications for neuropathic pain are recommended. To support the Quality of life in patients, selection of medication is made on such recommendations.

Keywords

Neuropathic pain;drugs

References

  1. Cruccu G. Treatment of painful neuropathy. Curr. Opin. NEUrol. 20, 531-535 (2007)
  2. Butera JA. Miniperspectives: recent approaches in treatment of neuropathic pain. J. Med. Chem. 50, 2543-2546 (2007) https://doi.org/10.1021/jm061015w
  3. Hall GC, Caroll D, Parry D, McQuay H. Epidemiology and treatment of neuropathic pain: The UK primary care perspective. Pain 122, 156-162 (2006) https://doi.org/10.1016/j.pain.2006.01.030
  4. Rowbotham MC. Mechanisms of neuropathic pain and their implications for the design of clinical trials. Neurology 65, S66-S73 (2005) https://doi.org/10.1212/WNL.65.12_suppl_4.S66
  5. Roza C, Lopez-Garcia JA. Retigabine, the specific KCNQ channel opener, blocks ectopic discharges in axotomized sensory fibres. Pain (2008) (Epub ahead of point).
  6. Kiefer Rt, Rohr P, Ploppa A et al. A pilot open-label study of the efficacy of subanethetic isomeric S+-ketamine in refractory CRPS patients. Pain Med. 9, 44-54 (2008) https://doi.org/10.1111/j.1526-4637.2006.00223.x
  7. Cvrcek P. Side effects of ketamine in long-term treatment of neuropathic pain. Pain Med. 9, 253-257 (2008) https://doi.org/10.1111/j.1526-4637.2007.00314.x
  8. AVANIR Pharmaceuticals. Improved patient-centered outcomes with dextromethorphan/quinidine vs placebo in a Phase III, double-blind, randomized, placebo-controlled trial investigating painful diabetic peripheral neuropathy. Presented at: 2nd International Congress On Neuropathic Pain. Berlin, Germany, 7-10 June 2007.
  9. Finnerup NB, Shindrup SH, Jensen TS. Chronic neuropathic pain: mechanism, drug targets and measurement. Fundam. Clin. Pharmacol. 21, 129-136 (2007) https://doi.org/10.1111/j.1472-8206.2007.00474.x
  10. Ji RR, Kawaski Y, Zhuang ZY, Wen YR, Decosterd I. Possible role of spinal strocytes in maintaining chronic pain sensitization: review of current evidence with focus on FGF/JNK pathway. Neuron Glia Biol. 2, 259-269 (2006) https://doi.org/10.1017/S1740925X07000403
  11. Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells and glia. Nature Neurosci. 10, 1361-1368 (2007) https://doi.org/10.1038/nn1992
  12. Finnerup NB, Jensen TS. Mechanism of disease: mechanism-based classification of neuropathic pain a critical analysis. Nature Clin. Pract. Neurol. 2, 107-115 (2006) https://doi.org/10.1038/ncpneuro0118
  13. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452-4. https://doi.org/10.1136/bmj.310.6977.452
  14. Finnerup NB et al. Algorithm for neuropathic pain treatment: An evidence based proposal. Pain 118, 289-305 (2005) https://doi.org/10.1016/j.pain.2005.08.013
  15. N. Attal et al. EFENS guidelines on pharmacological treatment of neuropathic pain. European J. Neurology 13:1153-1169 (2006) https://doi.org/10.1111/j.1468-1331.2006.01511.x
  16. Robert H. Dworkin et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain 132, 237-251 (2007) https://doi.org/10.1016/j.pain.2007.08.033
  17. O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med 2009; 122(10, Suppl):S22-S32 https://doi.org/10.1016/j.amjmed.2009.04.007
  18. Dworkin RH, O'Connor AB, Backonja M. et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain; 132(2): 237-251 (2007) https://doi.org/10.1016/j.pain.2007.08.033
  19. Khoromi S. Cui L. Nackers L. Max MB. Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain. Pain 2007;130:65-75
  20. Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S, et al. Opioid versus antidepressants in postherpetic neuralgia: a randomized, placebo controlled trial. Neurology 2002;59:1015-21 https://doi.org/10.1212/WNL.59.7.1015
  21. Eisenberg E, McNichol ED, Carr DB. Efficacy and safety of opioid agonists in treatment of neuropathic pain of nonmalignant origin: systemic review and meta-analysis of randomized controlled trials. JAMA 2005;293:3043-52 https://doi.org/10.1001/jama.293.24.3043
  22. Daniell HW. Hypogonadism in men consuming sustained action oral opioids. J Pain 2002;3:377-84 https://doi.org/10.1054/jpai.2002.126790
  23. Vallejo R, de Leon-Casasola O, Benyamin R. Opioid therapy and immunosuppression: a review. Am J Ther 2004;11:354-65 https://doi.org/10.1097/01.mjt.0000132250.95650.85
  24. Chu LF, Clark DJ, Angst MS. Opioid tolerance and hyperalgegia in chronic pain patients after one month of oral morphine therapy: a preliminary prospective study. J pain 2006;7:43-8 https://doi.org/10.1016/j.jpain.2005.08.001
  25. Martell BA, O'Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR. et al. Opioid treatment for chronic back pain: prevalence, efficacy and association with addiction. Ann Intern Med 2007;37:116-27