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对神经性疼痛的药物治疗和非侵入性神经调节:系统性审查和元分析

Nadia Soliman¹, Xavier Moisset², Michael C Ferraro³

¹Pain Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.

The Lancet. Neurology

|April 19, 2025

概括

这项研究更新了神经病痛治疗指南. 三环抗抑郁药 (TCA),α2δ-连接剂和SNRIs是强烈推的第一线治疗方法,为神经病痛提供适度的益处,具有可管理的风险.

科学领域:

神经学神经学
疼痛管理疼痛管理
药理学药理学是指药理学的学科.

背景情况:

对于有效和安全的神经病痛治疗,存在着大量未满足的需求.
此前的治疗建议于2015年发表.
这项研究结合了随机对照试验和神经调节技术的新证据.

研究的目的:

更新神经病痛的治疗建议.
综合来自药理学和神经调节干预的证据.
为临床医生和患者提供基于证据的指导.

主要方法:

系统审查和双盲,随机,安慰剂对照试验的元分析.
搜索了Embase,PubMed和临床试验注册表 (数据截至2024年2月12日).
提取了疗效 (响应率) 和安全性 (不良事件撤销) 数据;计算了NNT和NNH.

主要成果:

包括313项试验,共有48789名参与者.
强烈推TCAs (NNT=4.6),α2δ-连接体 (NNT=8.9),SNRIs (NNT=7.4) 作为第一线治疗.
对素贴片,奶油,利多卡因贴片,BTX-A,rTMS和阿片类药物作为二线或三线治疗的弱点建议,有效性和安全性概况各不相同.

结论:

结果支持修订神经病痛特殊兴趣小组的建议.
治疗结果是温和的,对于一些干预措施仍然存在不确定性.
需要进一步进行大型的安慰剂对照试验,以澄清临床相关时间的治疗疗效和安全性.

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