Neuropathic pain - STUD：神经病理性疼痛的螺柱.pptVIP

Neuropathic pain 1. Mechanism 2. Characteristic 3. Diagnosis 4. Treatment Neuropathic pain Mechanism of pain: caused by cancer nerve compression - nerve root compression caused by a collapsed vertebra total tumor mass = neoplasm + surrounding inflammation nerve infiltration by cancer nerve injury Neuropathic pain Mechanism of pain: caused by treatment postoperative (neurotomy) phantom limb pain, post-mastectomy pain radiotherapy (fibrosis) e.g. Brachial plexopathy chemotherapy - peripheral neuropathy (wincristine, cisplatine, taxol) Neuropathic pain Mechanism of pain: post-herpetic neuralgia diabetic neuropathy post-stroke pain uraemic neuropathy Neuropathic pain Pain characteristic: superficial burning pain spontaneous stabbing/shooting pain boring and radiating pain allodynia - pain caused by a stimulus which does not normally provoke pain hyperalgesia - an increased response to a stimulus which is normally painful Neuropathic pain Diagnosis: history clinical examination neurological examination MRI / CT Neuropathic pain Treatment: I. Adiuvant analgesics II. Corticosteroids III. Analgesics (opioids) IV. Neurolysis, spinal analgesia Neuropathic pain Corticosteroids (reduces total tumor mass) e.g. Dexamethason 16-24mg at the begining and then reduse dose Antidepressants - tricyclic antidepressants (amitriptyline, desipramine, doxepin, imipramine, clomipramine) SSRI (paroxetine, citalopram, fluoxetine) Neuropathic pain Amitriptyline is effective in migraine and other types of headache, chronic low back pain, post-herpetic neuralgia, fibromialgia, painful diabetic polyneuropathy, central pain, cancer pain. Superficial burning pain, allodynia = tricyclic antidepressants 10-25mg nocte at the begining; max 75mg relief may not occur for 4-5 days, for effect you have to wait even 1-2 weeks Neuropathic pain Anticonvulsants - carbamazepine, gabapentin, valproate, oxcarbazepine, lamotrigine spontaneous stabbing/shooting pain carbamazepine 200-1600mg; effect after 10-14 day