神经性疼痛的干预:系统评论
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译,敬请关注并提出宝贵意见
Interventions for Neuropathic Pain: An Overview of Systematic Reviews
背景与目的
可以使用许多神经性疼痛(NeuP)干预措施,但其治疗仍然不能令人满意。
方 法
我们系统地总结了随机对照试验对NeuP干预措施的系统评价(SR)的证据。截至2015年3月,搜查了五个电子数据库。使用A测量工具分析研究质量以评估系统评价。
结 果
97例中最常见的干预措施包括SR(药物)(59%)和手术(15%)。大多数分析的系统评价是中等质量的。关于疗效的摘要中有超过50%的结论和大约80%的安全性结论是不确定的。描述了有效的干预措施,如疼痛性糖尿病性神经病变(普瑞巴林,加巴喷丁,某些三环抗抑郁药,阿片类,抗抑郁药和抗惊厥药),带状疱疹后神经痛(加巴喷丁,普瑞巴林,某些TCA,抗抑郁药和抗惊厥药,阿片样物质,丙戊酸钠,局部辣椒素,和利多卡因),腰神经根痛(硬膜外皮质类固醇,重复经颅磁刺激[rTMS]和椎间盘切除术),颈部根性疼痛(rTMS),腕管综合征(腕管释放),肘管综合征(简单减压和尺神经转位) ,三叉神经痛(卡马西平,拉莫三嗪和难治性病例的匹莫齐特,rTMS),HIV相关神经病变(局部辣椒素)和中枢神经痛(某些TCA,普瑞巴林,大麻素和rTMS)。
结 论
关于神经痛干预措施的证据往往不确定或完全缺乏。 关于神经痛干预措施的新的随机对照试验是必要的; 他们应该解决安全问题并使用明确的诊断标准。
原始文献摘要
Svjetlana Dosenovic, MD,* Antonia Jelicic Kadic, MD, PhD,† Maja Miljanovic, MA, et al. Interventions for Neuropathic Pain: An Overview of Systematic Reviews.[J]. Anesth Analg 2017;125:643–52
PURPOSE:
Numerous interventions for neuropathic pain (NeuP) are available, but its treatment remains unsatisfactory.
METHODS:
We systematically summarized evidence from systematic reviews (SRs) of randomized controlled trials on interventions for NeuP. Five electronic databases were searched up to March 2015. Study quality was analyzed using A Measurement Tool to Assess Systematic Reviews.
RESULTS:
The most common interventions in 97 included SRs were pharmacologic (59%) and surgical (15%). Themajority of analyzed SRs were of medium quality. More than 50% of conclusions from abstracts on efficacy and approximately 80% on safety were inconclusive. Effective interventions were described for painful diabetic neuropathy (pregabalin, gabapentin, certain tricyclic antidepressants [TCAs], opioids, antidepressants, and anticonvulsants), postherpetic neuralgia (gabapentin, pregabalin, certain TCAs, antidepressants and anticonvulsants, opioids, sodium valproate, topical capsaicin,and lidocaine), lumbar radicular pain (epidural corticosteroids, repetitive transcranial magnetic stimulation [rTMS], and discectomy), cervical radicular pain (rTMS), carpal tunnel syndrome (carpal tunnel release), cubital tunnel syndrome (simple decompression and ulnar nerve transposition), trigeminal neuralgia (carbamazepine, lamotrigine, and pimozide for refractory cases, rTMS), HIVrelated neuropathy (topical capsaicin), and central NeuP (certain TCAs, pregabalin, cannabinoids, and rTMS).
CONCLUSION:
Evidence about interventions for NeuP is frequently inconclusive or completely lacking. New randomized controlled trials about interventions for NeuP are necessary; they should address safety and use clear diagnostic criteria.
![](http://n4.ikafan.com/assetsj/blank.gif)
麻醉学文献进展分享
联系我们