Anticonvulsant對diabeticneuropathicpain的效果.pptVIP

Anticonvulsants治療diabetic neuropathic pain的效果 小港醫院 R2董錦松 臨床問題 Anticonvulsants對diabetic neuropathic pain的治療效果如何？ 若anticonvulsants治療diabetic neuropathic pain有效，那一種anticonvulsant為最佳選擇？ 背景說明 1960年代起，即開始使用anticonvulsants來治療neuropathic pain，如diabetic neuropathy，trigeminal neuralgia，post-herpetic neuralgia等。 Diabetic neuropathic pain是臨床上常見之病症，困擾許多DM病人，近年來多種新的anticonvulsants上市，是否也代表治療diabetic neuropathic pain的選擇更多，副作用更少，因此找尋文獻比較各種anticonvulsants對diabetic neuropathic pain的療效。 Diabetic peripheral neuropathy 15% DM p’t have S/S of neuropathy DM25 years? affect nearly 50% p’t Pathogenesis: unknown Hyperglycemia Microvascular diasease Treatment: TCAs, NSAID, anticonvulsants, opioids, topical anesthetic agents, nerve block 期待目標 anticonvulsants對diabetic neuropathic pain的治療效果，並找出何種anticonvulsants 是最佳的選擇。 搜尋步驟 搜尋字串： Neuropathy anticonvulsant, anticonvulsants, carbamazepine, oxcarbazepine, valproate, phenytoin, lamotrigine, vigabatrin, gabapentin, topiramate Clinical trial (PubMed) 搜尋範圍： ACP Journal Club -- 1 Cochrane Database of Systematic Reviews -- 1 Cochrane Central Register of Controlled Trials, PubMed -- 15 結 果 結果摘要(I) Cochrane Database of Systematic Reviews Anticonvulsant drugs for acute and chronic pain (2000) Diabetic Neuropathy: Four placebo-controlled studies one with carbamazepine (Rull 1969), two with phenytoin (Chadda 1978, Saudek 1977), and one with gabapentin (Backonja 1998)). Rull (Rull 1969) and Chadda (Chadda 1978) found that with two weeks treatment between 30 and 50% more patients improved on anticonvulsant than on placebo. Saudek 1977, using phenytoin (300 mg/day) for 23 weeks of treatment found no difference in mean pain intensity compared with placebo Backonja (Backonja 1998) reported a 60% improvement on a global scale for patients on gabapentin (up to 3.6 grams per day) after four weeks treatment in a study of 165 participants. one active control study comparing carbamazepine 200 mg versus a nortriptyline 10 mg/fluphenazine 0.5 mg combination (Gomez