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Vol. 70 (2011) No. 3 P 167-173



特集 「最近の脳科学」

Neuropathic pain is characterized by partial or complete somatosensory changes in the innervation territory corresponding to peripheral or central nervous system pathology, and the paradoxical occurrence of pain and hypersensitivity phenomenon within the denervated area and its surroundings. In clinical practice, electrical pain and allodynia are the most important findings in the diagnosis of typical neuropathic pain. The best way to relive neuropathic pain is considered to be pharmacologic treatment, except for NSAIDs. Evidence-based clinical recommendations for pharmacotherapy are required. Recommended first-line treatments include certain 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 primary care physician should be familiar with neuropathic pain and prescribe adequate medications based on recommended first-line treatments. Therefore the pain clinician should provide information to the primary care physician regarding what is neuropathic pain, how to diagnose it, how to assess spontaneous pain intensity and characteristics, how to examine sensory disturbance, how to prescribe antidepressants and antiepileptics, how to pay attention to potential side effects, and how to decide when to refer to a pain clinic.

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