「難治性疼痛の診断と最新の治療」難治性疼痛に対する薬物療法　　非オピオイドとオピオイド

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  • 加藤 実
    日本大学医学部麻酔科学系麻酔科学分野

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タイトル別名
  • Pharmacotherapy for Intractable Pain
  • 難治性疼痛に対する薬物療法 非オピオイドとオピオイド
  • ナンチセイ トウツウ ニ タイスル ヤクブツ リョウホウ ヒオピオイド ト オピオイド

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Neuropathic pain is characterized by partial or complete somatosensory change in the innervation area corresponding to peripheral or central nervous system pathology, and the paradoxical occurrence of pain and hypersensitivity phenomenon within the denervated area and its surroundings. The management of patients with neuropathic pain is complex and the response to conventional treatment is often inadequate. Treatment of neuropathic pain is still difficult despite new therapeutic approaches, and there is no single treatment that works for all conditions and their underlying mechanisms. Appropriate diagnosis and assessment are critical to the successful treatment of neuropathic pain in each patient. The best way to relive neuropathic pain is considered to be with pharmacologic treatment. Evidence-based clinical recommendations for pharmacotherapy are necessary. Recommended first-line treatments include antidepressants (tricyclic antidepressant) and antiepileptics (gabapentin and pregabalin). Opioid analgesics are generally recommended as a second-line treatment. To reduce the number of patients who suffer from neuropathic pain, the physician should be familiar with neuropathic pain and should prescribe adequate medications based on recommended first-line treatments. However, unfortunately, the pharmacologic treatments for neuropathic pain are limited, with no more than 40-60% of patients obtaining partial pain relief of their pain. Ongoing development of new medications for neuropathic pain, additional trials involving existing medications alone and in combination are needed to advance the management of neuropathic pain.

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