痛性周围神经病 课件.ppt

 2002年11月15-17日在西班牙巴塞罗那举行ICNeP医师论坛，许多疼痛和非疼痛科医师讨论了以下疾病的药物治疗方案： 糖尿病性痛性周围神经病变 带状疱疹后神经痛 三叉神经痛 中枢性中风后疼痛 脊髓损伤 复杂的局部疼痛综合征II型 普瑞巴林 2004年 FDA批准用于治疗糖尿病性神经痛和带状疱疹性神经病. It is a structural, but not functional, analogue of GABA. It acts as a ligand of the alpha2-delta subunit, a protein associated to the voltage-dependent calcium channels. Modulation of these channels decreases calcium entry into nerve endings, resulting in a decreased release of several excitatory neurotransmitters.  Pregabalin had a linear pharmacokinetics with little variability between the different subjects. It does not bind to plasma proteins, has no liver metabolism, and is excreted trough the kidneys. Few interactions with other drugs may be expected based on these characteristics. Pregabalin in the treatment of neuropathic pain Biegstraaten M, van Schaik IN. Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Neurologie, Meibergdreef 9, 1105 AZ Amsterdam. Ned Tijdschr Geneeskd. 2007 Jul 14;151(28):1561-5.  Pregabalin is increasingly being used for the treatment ofneuropathic pain, often as the first-line choice. The question is, however, whether this choice is based on evidence. Seven trials have been published on the effect ofpregabalin in patients with postherpetic neuralgia and painful diabetic neuropathy. These trials more frequently report a 50% reduction in pain in pregabalin treated patients than in patients treated with placebo (number needed to treat 4.3). 其它神经痛 三叉神经痛治疗方案 酰胺咪嗪 最大剂量为1200 mg Gabapentin 最大剂量为2400-3600 mg Oxcarbazepine 最大剂量为1600 mg 各种组合:如酰胺咪嗪/gabapentin 或gabapentin/oxcarbazepine 一线 二线 三线 Baclofen 最大剂量为 30-80 mg Lamotrigine 最大剂量为 25-500 mg 脊髓损伤治疗方案 TCAs 平均剂量为75mg 逐渐调整剂量 Gabapentin 逐渐调整剂量 直至 3600 mg Gabapentin 可达3600 mg Lamotrigine 可达400 mg 阿片类药物逐渐调整剂量 阿片类药物逐渐调整剂量 Amitriptyline 平均剂量为 75 mg Lamotrigine 可达400 mg 联合用药 建议并考虑鞘内治疗和/或手术治疗 一线 二线 三线 中风后中枢性疼痛治疗方案 阿米替林75-100 mg Gabapentin可达3600 mg Lamotrigine200 mg Amitrip