Có gì mới trong cơn đau thần kinh?

Springer Science and Business Media LLC - Tập 15 - Trang 363-372 - 2006
Mellar P. Davis1
1The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Health System, Cleveland, USA

Tóm tắt

Cơn đau thần kinh xảy ra ở 1% dân số và rất khó để quản lý. Phản ứng với các loại thuốc đơn lẻ có lợi ích hạn chế. Ba mươi phần trăm bệnh nhân sẽ không đáp ứng với điều trị. Đây là một bài đánh giá về các loại thuốc và phương pháp điều trị mới hơn. Một cuộc tổng quan tài liệu đã được thực hiện liên quan đến các loại thuốc mới và các thuật toán điều trị trong việc quản lý cơn đau thần kinh. Thông tin mới về các thuốc opioid (tramadol và buprenorphine) gợi ý rằng chúng có lợi trong việc quản lý cơn đau thần kinh và đã tăng cường sự quan tâm tới việc sử dụng chúng sớm trong quá trình bệnh. Các thuốc chống trầm cảm mới hơn, ức chế tái hấp thu serotonin và noradrenaline chọn lọc (SNRIs) có bằng chứng về lợi ích và giảm độc tính mà không có bất lợi kinh tế so với các thuốc chống trầm cảm ba vòng (TCAs). Pregabalin và gabapentin có hiệu quả trong bệnh thần kinh tiểu đường và đau thần kinh sau zona. Các phương pháp điều trị đang chuyển hướng từ thử nghiệm thuốc đơn lẻ một cách tuần tự sang liệu pháp đa thuốc. Cần có bằng chứng để biện minh cho sự thay đổi này trong cách tiếp cận điều trị. Lựa chọn thuốc hiện nay không chỉ dựa vào hiệu quả mà còn dựa vào độc tính và tương tác thuốc. Vì lý do này, SNRIs và gabapentin/pregabalin đã trở nên phổ biến mặc dù hiệu quả không tốt hơn TCAs. Liệu pháp đa thuốc đang trở thành một phương pháp điều trị nổi bật và cần nghiên cứu thêm về liệu pháp đa thuốc.

Từ khóa

#cơn đau thần kinh #thuốc chống trầm cảm #opioid #liệu pháp đa thuốc

Tài liệu tham khảo

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