Contemporary management of neuropathic pain for the primary care physician

被引:71
作者
Chen, HP
Lamer, TJ
Rho, RH
Marshall, KA
Sitzman, BT
Ghazi, SM
Brewer, RP
机构
[1] Duke Univ, Med Ctr, Div Pain Med, Durham, NC USA
[2] Mayo Clin, Coll Med, Dept Pain Management, Jacksonville, FL 32224 USA
[3] Mayo Clin, Coll Med, Div Pain Med, Rochester, MN 55905 USA
关键词
D O I
10.4065/79.12.1533
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Neurdpathic pain (NP), caused by a primary lesion,or dysfunction in the nervous system,, affects approximately 4 million people In the United States each year. It Is associated with many diseases, Including diabetic peripheral neuropathy, postherpetic neuralgia, human Immunodeficiency virus-related disorders, and chronic radiculopathy. Major pathophysiological mechanisms Include peripheral sensitization, sympathetic activation, disinhibition, and central sensitization. Unlike most acute pain conditions, NP Is extremely difficult to treat successfully with conventional analgesics. This article introduces a contemporary management approach, that Is, one that Incorporates nonpharmacological, pharmacological, and Interventional strategies. Some nonpharmacological management strategies Include patient education, physical rehabilitation, psychological techniques, and complementary medicine.. Pharmacological strategies include the use of first-line agents that have been supported by randomized controlled trials. Finally, referral to a pain specialist may be indicated for additional assessment, Interventional techniques, and rehabilitation. Integrating a comprehensive approach to NP gives the primary care physician and patient the greatest chance for success.
引用
收藏
页码:1533 / 1545
页数:13
相关论文
共 97 条
[1]   Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations [J].
Ackerman, LL ;
Follett, KA ;
Rosenquist, RW .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2003, 26 (01) :668-677
[2]  
[Anonymous], MOD GUID US CONTR SU
[3]   Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus - A randomized controlled trial [J].
Backonja, M ;
Beydoun, A ;
Edwards, KR ;
Schwartz, SL ;
Fonseca, V ;
Hes, M ;
LaMoreaux, L ;
Garofalo, E .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (21) :1831-1836
[4]   Gabapentin dosing for neuropathic pain: Evidence from randomized, placebo-controlled clinical trials [J].
Backonja, M ;
Glanzman, RL .
CLINICAL THERAPEUTICS, 2003, 25 (01) :81-104
[5]   Defining neuropathic pain [J].
Backonja, MM .
ANESTHESIA AND ANALGESIA, 2003, 97 (03) :785-790
[6]   Use of anticonvulsants for treatment of neuropathic pain [J].
Backonja, MM .
NEUROLOGY, 2002, 59 (05) :S14-S17
[7]  
BACKONJA MM, 2004, ANESTH ANALG, V98, P67
[8]   Opioid therapy for chronic pain [J].
Ballantyne, JC ;
Mao, JR .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (20) :1943-1953
[9]  
Bennett GJ, 1997, PROG PAIN RES MANAG, V9, P109
[10]   Injections and surgical therapy in chronic pain [J].
Bernstein, RM .
CLINICAL JOURNAL OF PAIN, 2001, 17 (04) :S94-S104