Current Approaches in Therapeutic Management of Chronic Neuropathic Pain

Solak Ö., Kavuncu V.

Romatizma , vol.23, pp.135-142, 2008 (Refereed Journals of Other Institutions)

  • Publication Type: Article / Review
  • Volume: 23
  • Publication Date: 2008
  • Title of Journal : Romatizma
  • Page Numbers: pp.135-142


Neuropathic pain is briefly defined as pain caused by a lesion in the nervous system and is common in clinical practice. Pharmacotherapy and neurostimulation therapy are the two most recommended thera- pies for the treatment of this condition. It is generally accepted that pharmacotherapy remains the mainstay of neuropathic pain manage- ment. First-line treatments include gabapentin, 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepres- sants. Neurostimulation techniques recommended in the treatment of neuropathic pain are transcutaneous electrical nevre stimulation (TENS), peripheral nerve stimulation (PNS), nerve root stimulation (NRS), spinal cord stimulation (SCS), deep brain stimulation (DBS), epidural motor cortex stimulation (MCS) and repetitive transcranial magnetic stimulation (rTMS). Treatment decisions for patients with neuropathic pain can often be difficult. Recently, growing interest in the mechanisms of chronic neuropathic pain has resulted in significant advances in treatment. In this review, recent knowledge on therapeu- tic management of chronic neuropathic pain is reviewed.

Key words: Neuropathic pain, treatment, algorithm

Nöropatik a¤r›, sinir sistemindeki bir lezyon nedeniyle ortaya ç›kan a¤r›d›r ve klinik pratikte s›k karfl›lafl›lan bir durumdur. Tan›da zor- luklar olabilir. Nöropatik a¤r› tedavisinde en s›k önerilen tedavi fle- killeri ilaç tedavisi ve nörostimülasyon tedavisidir. Genel olarak, nöropatik a¤r› tedavisinin en önemli bölümünü farmakoterapinin oluflturdu¤u kabul edilir. ‹lk s›ra tedaviler aras›nda gabapentin, %5’lik lidokain yamas›, opioid analjezikler, tramadol hidroklorid ve trisiklik antidepresanlar vard›r. Kronik nöropatik a¤r› edavisin- de önerilen nörostimülasyon teknikleri; transkutanöz elektriksel sinir stimülasyonu (TENS), periferik sinir stimülasyonu (PNS), sinir kökü stimülasyonu (NRS), spinal kord stimülasyonu (SCS), derin be- yin stimülasyonu (DBS), epidural motor korteks stimülasyonu (MCS) ve tekrarlayan transkraniyal manyetik stimülasyon (rTMS) uygulamalar›d›r. Nöropatik a¤r›s› olan hastalarda tedavide ne kul- lan›laca¤›na karar vermek zor olabilir. Son y›llarda kronik a¤r› me- kanizmalar› ve tedavisine olan ilgi artm›flt›r ve bu da tedavide önemli geliflmeler sa¤lam›flt›r. Bu derlemede kronik nöropatik a¤- r›n›n tedavisi ile ilgili son bilgiler sunulmufltur.

Anahtar sözcükler: Nöropatik a¤r›, tedavi, algoritma