文档介绍：Neuropathic pain
1. Mechanism
2. Characteristic
3. Diagnosis
4. Treatment
Neuropathic pain
Mechanism of pain: caused by cancer
pression - nerve pression 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) . 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) . 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