糖尿病痛性神经病变.ppt

Targets for Controlling Neuropathic Pain Now there are multiple neurotransmitters and different channels that mediate the electrical activity in the afferent pathways, and many of these are at least a potential target for controlling neuropathic pain. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter, and one would imagine that if one can increase inhibition in the pain pathways, you might reduce pain. Tackling GABA has been a bit disappointing, I must say, but it, at least, is a potential target for neuropathic pain. The sodium channels on the axons can also be blocked, reducing both peripheral and central sensitization so that there's less of this aberrant signal traffic. A newer mechanism that has generated a lot of interest is modulation of the calcium channels. Not calcium-channel blockade a?' like you would do with verapamil or nifedipine a?' but modulation of the calcium channel activity. So, it does not alter normal calcium traffic, but reduces abnormal increased calcium channel traffic, and by that mechanism, it results in reduced afferent signal traffic, reduced pain. * Pharmacologic Treatments for Neuropathic Pain There are multiple different classes of agents that have shown to be effective in the treatment of neuropathic pain. Interestingly, you can even put stuff on the skin, like the lidocaine patch or lidocaine creams and capsaicin. Both of these agents have been studied in double-blind, placebo-controlled studies and been shown to be effective in the reduction of neuropathic pain, although capsaicin is not Food and Drug Administration (FDA)-approved for this purpose. The opioids, in general, are effective in the treatment of neuropathic pain. Opioids are relatively more effective in the treatment of nociceptive pain, but they are effective in the treatment of neuropathic pain. They should not be used as first-line treatments, but do have an important role. Antidepressant drugs, both of the tricyclic type and the more recently introdu