Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar

SOLAK, Özlem; KAVUNCU, Vural

Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar

Özlem SOLAK, (Kocatepe Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Afyonkarahisar, Türkiye)

Vural KAVUNCU (Kocatepe Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Afyonkarahisar, Türkiye)

Romatizma Dergisi

34 5

Yıl: 2008 Cilt: 23 Sayı: 4 Sayfa Aralığı: 135 - 142 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar

Öz:

Nöropatik ağrı, sinir sistemindeki bir lezyon nedeniyle ortaya çıkan ağrıdır ve klinik pratikte sık karşılaşılan bir durumdur. Tanıda zorluklar olabilir. Nöropatik ağrı tedavisinde en sık önerilen tedavi şekilleri ilaç tedavisi ve nörostimülasyon tedavisidir. Genel olarak, nöropatik ağrı tedavisinin en önemli bölümünü farmakoterapinin oluşturduğu kabul edilir. İlk sıra tedaviler arasında gabapentin, %5'lik lidokain yaması, opioid analjezikler, tramadol hidroklorid ve trisiklik antidepresanlar vardır. Kronik nöropatik ağrı edavisinde önerilen nörostimülasyon teknikleri; transkutanöz elektriksel sinir stimülasyonu (TENS), periferik sinir stimülasyonu (PNS), sinir kökü stimülasyonu (NRS), spinal kord stimülasyonu (SCS), derin beyin stimülasyonu (DBS), epidural motor korteks stimülasyonu (MCS) ve tekrarlayan transkraniyal manyetik stimülasyon (rTMS) uygulamalarıdır. Nöropatik ağrısı olan hastalarda tedavide ne kullanılacağına karar vermek zor olabilir. Son yıllarda kronik ağrı mekanizmaları ve tedavisine olan ilgi artmıştır ve bu da tedavide önemli gelişmeler sağlamıştır. Bu derlemede kronik nöropatik ağrının tedavisi ile ilgili son bilgiler sunulmuştur.

Anahtar Kelime: İlaç tedavisi Ağrı Nevralji Elektrik uyarı tedavisi Algoritma Nörolojik belirtiler Transkutanöz elektrik sinir uyarımı Fizik tedavi yöntemleri Kronik hastalık

Konular: Genel ve Dahili Tıp

Current approaches in therapeutic management of chronic neuropathic pain

Öz:

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 therapies for the treatment of this condition. It is generally accepted that pharmacotherapy remains the mainstay of neuropathic pain management. First-line treatments include gabapentin, 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants. 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 therapeutic management of chronic neuropathic pain is reviewed.

Anahtar Kelime: Algorithms Neurologic Manifestations Transcutaneous Electric Nerve Stimulation Physical Therapy Modalities Chronic Disease Drug Therapy Pain Neuralgia Electric Stimulation Therapy

Konular: Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Merskey H, Bogduk N. Classification of Chronic Pain. 2nd edition. Seattle, WA: IASP Press; 1994.
2. De Andres J, Garcia-Ribas G. Neuropathic pain treatment: The challenge. Pain Practice. 2003; 3: 1-7.
3. Lineberry CG, Vierck CJ. Attenuation of pain reactivity by caudate nucleus stimulation in monkeys. Brain Res. 1975; 98: 119-34.
4. Vadalouca A, Siafaka I, Argyra E, Vrachnou E, Moka E. Therapeutic management of chronic neuropathic pain. Ann. N.Y. Acad. Sci. 2006; 1088: 164-86.
5. Chong MS, ZH Bajwai. Diagnosis and treatment of neuropathic pain. J. Pain Symptom Manage. 2003; 25: S4-S11.
6. Ozra, F. Neuropathic pain. review of mechanisms and pharmacologic management. Neurorehabilitation 2000; 14: 15-23.
7. Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, et al. Advances in neuropathic pain: diagnosis, mechanisms and treatment recommendations. Arch Neurol 2003; 60: 1524-35.
8. Irving GA. Contemporary assessment and management of neuropathic pain. Neurology 2005; 64: S21-S27.
9. Namaka M, Gramlich CR, Ruhlen D, Melanson M, Sutton I, Major J. A treatment algorithm for neuropathic pain. Clin Ther 2004; 26: 951-79.
10. Ramsay RE. Clinical efficacy and safety of gabapentin. Neurol 1994. 1994; 44: S23-S30.
11. Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998; 280: 1831-6.
12. Gorson KC, Schott C, Herman R, Ropper AH, Rand WM. Gabapentin in the treatment of painful diabetic neuropathy: a placebo-controlled, double-blind, crossover trial. J Neurol Neurosurg Phychiatry 1999; 66: 251-2.
13. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280: 1837-42.
14. Rice AS, Maton S. Postherpetic neuralgia study group. Gabapentin in postherpetic neuralgia: a randomized, doubleblind, placebo controlled study. Pain 2001; 94: 215-24.
15. Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med 2002; 27: 481-6.
16. Pandey CK, Bose N, Garg G, Singh N, Baronia A, Agarwal A, et al. Gabapentin for the treatment of pain in Guillain-Barr´e syndrome: a double-blind, placebo- controlled, cross-over study. Anesth Analg 2002; 95: 1719-23.
17. Tai Q, Kirshblum S, Chen B, Millis S, Johnston M, DeLisa JA. Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial. J. Spinal Cord Med 2002; 25: 100-5.
18. Van de Vusse AC, Stomp-van den Berg SG, Kessels AH, Weber WE. Randomized, controlled trial of gabapentin in complex regional pain syndrome type I. BMC Neurol. 2004; 4: 13-9.
19. Serpell M; Neuropathic pain study group. Gabapentin in neuropathic pain syndromes: a randomized, double-blind, placebo- controlled trial. Pain 2002; 99: 557-66.
20. Caraceni A, Zecca E, Bonezzi C, Arcuri E, Yaya Tur R, Maltoni M, et al. Gabapentin for neuropathic cancer pain: a randomized, controlled trial from the gabapentin cancer pain study group. J Clin Oncol 2004; 22: 2909-17.
21. Moka E. The role of gabapentin in chronic neuropathic pain in MS patients: a 4-year experience [abstract]. 2nd International Symposium of Regional Anaesthesia and Pain Therapy, 2004, Chile.
22. Solak O, Metin M, Esme H, Solak Ö, Yaman M, Pekcolaklar A, Gurses A, Kavuncu V. Effectiveness of gabapentin in the treatment of chronic post-thoracotomy pain. Eur J Cardiothorac Surg. 2007; 32: 9-12.
23. Solak Ö, Çetin E, Yakşi A, Demir SE, Burnaz Ö, Özaras N. Lomber Disk Herniyasyonu Nedeniyle Opere Olmufl Hastalarda Epidural Fibrozise Bağlı ağrıda Gabapentinin ve Karbamazepinin Etkinliğinin Kaşılaştırılması. Hipokrat Lokomotor, 2005; 6: 33.
24. Rowbotham MC, Davies PS, Verkempinck C, Galer BS. Lidocaine patch: double-blind, controlled study of a new treatment for post-herpetic neuralgia. Pain 1996; 65: 39-44.
25. Galer BS, Rowbotham MC, Perander J, Friedman E. Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain 1999; 80: 533-8.
26. Meier T, Wasner G, Faust M, Kuntzer T, Ochsner F, Hueppe M, et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomized, double- blind, placebocontrolled study. Pain 2003; 106: 151-8.
27. Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy. A randomized controlled trial. Neurology 2003; 60: 927-34.
28. Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 1998; 50: 1837-41.
29. Huse E, Larbiq W, Flor H, Birbaumer N. The effect of opioids on phantom limb pain and cortical reorganization. Pain 2001; 90: 47-55.
30. Morley JS, Bridson J, Nash TP, Miles JB, White SMakin MK. Low-dose methadone has an analgesic effect in neuropathic pain: a double-blind randomized controlled crossover trial. Palliative Med 2003; 17: 576-87.
31. Eisenberg E, mcNicol ED, Carr DB. Efficacy and safety of opioid agonists in the treatment of neuropathic pain of non-malignant origin. JAMA 2005; 293: 3043-52.
32. Beniczky S, Tajti J, Timea Varga E, Vecsei L. Evidence-based pharmacological treatment of neuropathic pain syndromes. J Neural Transm 2005; 112: 735-49.
33. Harati Y, Gooch C, Swenson M, Edelman S, Grene D, Raskin P, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology 1998; 50:1842-6.
34. Sindrup SH, Andersen G, Madsen C, Smith T, Brosen K, Jensen TS. Tramadol relieves pain and allodynia in polyneuropathy: a randomized double-blind controlled trial. Pain 1999; 83: 85-90.
35. Boureau F, Leqallicier P, Kabir-Ahmadi M. Tramadol in postherpetic neuralgia: a randomized doubleblind placebo-controlled trial. Pain 2003; 104: 323-31.
36. Beydoun A, Backonja MM. Mechanistic stratification of antineuralgic agents. J. Pain Symptom Manage. 2003; 25: S18-S30.
37. Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medication: association with use of tricyclic agents. Am J Med 2000; 108: 2-8.
38. Max M.B. Thirteen consecutive well designed randomized trial show that antidepressants reduce pain in diabetic neuropathy and post herpetic neuralgia. Pain Forum 4. 1995 : 248-53.
39. Eisenberg E, Lurie Y, Braker C, Daoud D, Ishay A. Lamotrigine reduces painful diabetic neuropathy: a randomized controlled study. Neurology 2001; 57: 505-9.
40. Vestergaard K, Andersen G, Gottrup H, Kristensen BT, Jensen TS. Lamotrigine for central poststroke pain: a randomized controlled trial. Neurology 2001; 56: 184-90.
41. Finnerup NB, Sindrup SH, Bach FW, Johannesen IL, Jensen TS. Lamotrigine in spinal cord injury pain: a randomized controlled trial. Pain 2002; 96: 375-83.
42. Simpson DM, Olney R, McArthur JC, Khan A, Godbold J, Ebel- Frommer K. A placebo controlled trial of lamotrigine for painful HIV-associated neuropathy. Neurology 2000; 54: 2115-9.
43. Sindrup SH, Bach FW, Madsen C, Gram LF, Jensen TS. Venlafaxine versus imipramine in painful polyneuropathy: a randomized-controlled trial. Neurology 2003; 60: 1284-9.
44. Macpherson RD. New directions in pain management. Drugs Today (Barc) 2002; 38: 135-45.
45. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, et al. EFNS guidelines on neurostimulation therapy for theraupatic pain. Eur J Neurol 2007; 14: 952-70.
46. North RB, Kidd DH, Farrokhi F. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 2005; 56: 98-106.
47. Kumar K, North R, Taylor R. Spinal cord stimulation versus conventional medical management: a prospective, randomised, controlled, multicentre study of patients with failed back surgery syndrome (PROCESS study). Neuromodulation 2005; 8: 213-8.
48. Hamani C, Schwalb JM, Rezai AR. Deep brain stimulation for chronic neuropathic pain: long-term outcome and the incidence of insertional effect. Pain 2006; 125: 188-96.
49. Alvaro M, Kumar D, Julka IS. Transcutaneous electrostimulation: emerging treatment for diabetic neuropathic pain. Diabetes Technol Ther 1999; 1: 77-80.
50. Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for chronic low back and leg pain and failed back surgery syndrome: a systematic review and analysis of prognostic factors. Spine 2005; 1: 152-60.

APA	SOLAK Ö, KAVUNCU V (2008). Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. , 135 - 142.
Chicago	SOLAK Özlem,KAVUNCU Vural Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. (2008): 135 - 142.
MLA	SOLAK Özlem,KAVUNCU Vural Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. , 2008, ss.135 - 142.
AMA	SOLAK Ö,KAVUNCU V Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. . 2008; 135 - 142.
Vancouver	SOLAK Ö,KAVUNCU V Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. . 2008; 135 - 142.
IEEE	SOLAK Ö,KAVUNCU V "Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar." , ss.135 - 142, 2008.
ISNAD	SOLAK, Özlem - KAVUNCU, Vural. "Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar". (2008), 135-142.

APA	SOLAK Ö, KAVUNCU V (2008). Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. Romatizma Dergisi , 23(4), 135 - 142.
Chicago	SOLAK Özlem,KAVUNCU Vural Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. Romatizma Dergisi 23, no.4 (2008): 135 - 142.
MLA	SOLAK Özlem,KAVUNCU Vural Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. Romatizma Dergisi , vol.23, no.4, 2008, ss.135 - 142.
AMA	SOLAK Ö,KAVUNCU V Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. Romatizma Dergisi . 2008; 23(4): 135 - 142.
Vancouver	SOLAK Ö,KAVUNCU V Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar. Romatizma Dergisi . 2008; 23(4): 135 - 142.
IEEE	SOLAK Ö,KAVUNCU V "Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar." Romatizma Dergisi , 23, ss.135 - 142, 2008.
ISNAD	SOLAK, Özlem - KAVUNCU, Vural. "Kronik nöropatik ağrı tedavisinde güncel yaklaşımlar". Romatizma Dergisi 23/4 (2008), 135-142.