[Diagnosis and treatment of the neuropathic pain] (original) (raw)

Abstract

Currently, no consensus on the optimal management of neuropathic pain exists and practices vary greatly worldwide. Possible explanations for this include difficulties in developing agreed diagnostic protocols and the coexistence of neuropathic, nociceptive and, occasionally, idiopathic pain in the same patient. Also, neuropathic pain has historically been classified according to its etiology (e.g., painful diabetic neuropathy, trigeminal neuralgia, spinal cord injury) without regard for the presumed mechanism(s) underlying the specific symptoms. A combined etiologic/mechanistic classification might improve neuropathic pain management. The treatment of neuropathic pain is largely empirical, often relying heavily on data from small, generally poorly-designed clinical trials or anecdotal evidence. Consequently, diverse treatments are used, including non-invasive drug therapies (antidepressants, antiepileptic drugs and membrane stabilizing drugs), invasive therapies (nerve blocks, ablat...

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  31. Minn YK•Kim SM Peer Reviewers Commentary 본 논문은 최근 문제가 되고 있는 만성 통증의 대표적인 질환인 신경병성 통증의 발병기전, 진단, 치료에 대해서 기술 하고 있다. 통증 개념의 변화는 과거에는 질병 위주 개념(disease based concept)에서 현재는 메카니즘 위주 개념 (mechanism based concept)으로 바뀌었다. 또한 필자가 밝힌 대로 신경병증성 통증 환자의 진단과 치료에는 다학 제적인 접근(multidisciplinary approach)이 필요하다. 따라서 여기에서 기술된 다양한 약물요법과 더불어서 신경 치료 (체성 신경과 교감신경치료), 물리치료 및 심리치료를 병행하는 것은 환자에게 많은 도움이 될 것으로 생각된다. 무엇보 다 중요한 것은 적절한 조기 치료로 통증을 조절하여, 평생 지속되는 난치성 만성 질환인 신경병증성 통증으로 이행되는 것을 예방하는 것이라 할 수 있다. [정리: 편집위원회]