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Nöropatik Ağrıda Farmakolojik Yaklaşımlar

Year 2024, Volume: 33 Issue: 2, 106 - 111, 30.06.2024
https://doi.org/10.17827/aktd.1472782

Abstract

Uluslararası Ağrı Çalışmaları Birliği, ağrıyı gerçek veya potansiyel doku hasarı ile ilgili olarak ortaya çıkan hoş olmayan emosyonel bir deneyim olarak tanımlanmaktadır. Nosiseptif, nöropatik ve psikojenik ağrı olmak üzere üç gruba ayrılmaktadır. Bunlardan biri olan nöropatik ağrı, nosiseptif ağrı türleri olan baş ağrısı, sırt ağrısı ve diğer kas-iskelet sistemi ağrıları gibi sıklıkla bildirilen diğer ağrı durumlarından farklıdır ve hem periferik hem de merkezi duyarlılık mekanizmalarını yansıtır. Nöropatik ağrısı olan hastaların tedavi yönetimi karmaşıktır. Nöropatik ağrı tedavisinde genellikle basamaklı bir tedavi yaklaşımı önerilmektedir. Birinci basamak tedavide; trisiklik antidepresanlar, serotonin ve norepinefrin geri alım inhibitörleri, kalsiyum kanallarının alfa-2 delta ligandı (gabapentin ve pregabalin), topikal lidokain yer almaktadır. Opioid analjezikler ve tramadol, genellikle ikinci basamak tedavisinde önerilmektedir fakat bazı belirlenmiş klinik durumlarda birinci basamak kullanım için de önerilebilir. Üçüncü basamak tedavisinde ise antiepileptikler, antidepresanlar, meksiletin, N-metil-D-aspartat reseptör antagonistleri ve topikal kapsaisin yer almaktadır. İlaç seçimi; muhtemel yan etkiler, potansiyel yararlı veya zararlı etkiler ve analjezik etkisinin hemen başlamasının gerekli olup olmadığı göz önünde bulundurularak kişiye özgü olarak yapılmalıdır.

References

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  • 2. Turk DC, Okifuji A. Pain terms and taxonomies of pain. In: Loeser JD, editor. Bonica’s Management.
  • 3. Finnerup NB, Otto M, Jensen TS, Sindrup SH. An Evidence-based algorithm for the treatment of neuropathic pain. MedGenMed 2007; 9(2): 36.
  • 4. Dworkin RH, O'Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS. Pharmacological treatment of neuropathic pain: Evidence-described recommendations. Pain: December 2007; 132(3): 237-251.
  • 5. Çeliker R. Kronik ağrı sendromları. Türk Fiziksel Tıp ve Rehabilatasyon Dergisi 2005; 51 (Özel Ek B):14-18.
  • 6. Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron 2006;52(1):77–92.
  • 7. Pamela F Bell. Foreword in Guidelines on the Management of Neuropathic Pain. The Clinical Resource Efficiency Support Team (CREST) February 2008;4-6.
  • 8. Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002.
  • 9. Yücel A, Çimen A. Nöropatik ağrı: Mekanizmalar, tanı ve tedavi. Ağrı Dergisi 2005;17: 5-13.
  • 10. Zimmermann M. Pathobiology of neuropathic pain. Eur J Pharmacol 2001;429 (Suppl. 3): 23-37.
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  • 12. Yağcı Ü, Saygın M. Ağrı Fizyopatolojisi .SDÜ Tıp Fak Derg. 2019; 26(2): 209-220.
  • 13. Xu L, Zhang Y, Huang Y. Advances in the treatment of neuropathic pain. Adv Exp Med Biol. 2016;904:117-29.
  • 14. Magrinelli F, Zanette G, Tamburin S. Neuropathic pain: diagnosis and treatment. Pract Neurol. 2013;13(5):292-307.
  • 15. Finnerup NB, Sindrup SH, Jensen TS. Evidence for the pharmacological treatment of neuropathic pain. Pain. 2010; 150 (3): 573–81.
  • 16. Attal N, Bouhassira D. Pharmacotherapy of neuropathic pain: which drugs, which treatment algorithms? Pain. 2015;156 (1):104-14.
  • 17. Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Ağrı.The Journal Of The International Association for the Study of Pain. 5 Aralık 2005; 118 (3): 289-305.
  • 18. Obata H. Analgesic Mechanisms of Antidepressants for Neuropathic Pain. Int J Mol Sci. 2017;18(11):2483.
  • 19. Szczudlik A, Dobrogowski J, Wordliczek J, Stepien A, Krajnik M, Leppert W, et al. Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society - Part One. Neurol Neurochir Pol. 2014; (48):262-271.
  • 20. Mendlik MT, Uritsky TJ. Treatment of neuropathic pain. Curr Treat Options Neurol. 2015;17(12):50.
  • 21. Toth C. Pregabalin: latest safety evidence and clinical implications for the management of neuropathic pain. Ther Adv Drug Saf. 2014;5(1):38-56.
  • 22. O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of the latest guidelines. Ben J Med. 2009; 122: S22–32.
  • 23. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. ;2013(8):1-79.
  • 24. Mu A, Weinberg E, Moulin DE, Clarke H. Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician. 2017;63(11):844-852.
  • 25. Kayaalp OS. Akılcıl Tedavi Yönünden Tıbbi Farmakoloji cilt 2. 13. Baskı.Ankara, Pelikan yayınevi,2021.
  • 26. Peng PW, Tumber PS, Gourlay D. Perioperative pain management of patients receiving methadone therapy. Can J Anaesth. 2005; 52 (5): 513–23.
  • 27. Schwartz S, Etropolski M, Shapiro DY, Okamoto A, Lange R, Haeussler J. Safety and efficacy of tapentadol ER in patients with painful diabetic peripheral neuropathy: results of a randomized-withdrawal, placebo-controlled trial. Curr Med Res Opin. 2011; 27 (1): 151–62.
  • 28. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1:1-60.
  • 29. Lakhan SE, Velasco DN, Tepper D. Botulinum Toxin-A for Painful Diabetic Neuropathy: A Meta-Analysis. Pain Med. 2015;16(9):1773-80.
  • 30. Ranoux D, Attal N, Morain F, Bouhassira D. Botulinum toxin type A induces direct analgesic effects in chronic neuropathic pain. Ann Neurol. 2008;64(3):274-83.
  • 31. Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, Furlan A, Gilron I, Gordon A, Morley-Forster PK, Sessle BJ, Squire P, Stinson J, Taenzer P, Velly A, Ware MA, Weinberg EL, Williamson OD; Canadian Pain Society. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328-35.
  • 32. Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018;3(3):1-90.
  • 33. Collins S, Sigtermans MJ, Dahan A, Zuurmond WW, Perez RS. NMDA receptor antagonists for the treatment of neuropathic pain. Pain Med. 2010;11(11):1726-42.
Year 2024, Volume: 33 Issue: 2, 106 - 111, 30.06.2024
https://doi.org/10.17827/aktd.1472782

Abstract

References

  • 1. IASP Subcommitee on Taxonomy. Classification of chronic pain: Description of chronic pain syndromes and definition of pain terms. Pain 1986;3;1-226.
  • 2. Turk DC, Okifuji A. Pain terms and taxonomies of pain. In: Loeser JD, editor. Bonica’s Management.
  • 3. Finnerup NB, Otto M, Jensen TS, Sindrup SH. An Evidence-based algorithm for the treatment of neuropathic pain. MedGenMed 2007; 9(2): 36.
  • 4. Dworkin RH, O'Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS. Pharmacological treatment of neuropathic pain: Evidence-described recommendations. Pain: December 2007; 132(3): 237-251.
  • 5. Çeliker R. Kronik ağrı sendromları. Türk Fiziksel Tıp ve Rehabilatasyon Dergisi 2005; 51 (Özel Ek B):14-18.
  • 6. Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron 2006;52(1):77–92.
  • 7. Pamela F Bell. Foreword in Guidelines on the Management of Neuropathic Pain. The Clinical Resource Efficiency Support Team (CREST) February 2008;4-6.
  • 8. Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002.
  • 9. Yücel A, Çimen A. Nöropatik ağrı: Mekanizmalar, tanı ve tedavi. Ağrı Dergisi 2005;17: 5-13.
  • 10. Zimmermann M. Pathobiology of neuropathic pain. Eur J Pharmacol 2001;429 (Suppl. 3): 23-37.
  • 11. Taşkapılıoğlu Ö, Zarifoğlu M. Santral nöropatik ağrı.Turkiye Klinikleri Dergisi 2006;2(5):58-63.
  • 12. Yağcı Ü, Saygın M. Ağrı Fizyopatolojisi .SDÜ Tıp Fak Derg. 2019; 26(2): 209-220.
  • 13. Xu L, Zhang Y, Huang Y. Advances in the treatment of neuropathic pain. Adv Exp Med Biol. 2016;904:117-29.
  • 14. Magrinelli F, Zanette G, Tamburin S. Neuropathic pain: diagnosis and treatment. Pract Neurol. 2013;13(5):292-307.
  • 15. Finnerup NB, Sindrup SH, Jensen TS. Evidence for the pharmacological treatment of neuropathic pain. Pain. 2010; 150 (3): 573–81.
  • 16. Attal N, Bouhassira D. Pharmacotherapy of neuropathic pain: which drugs, which treatment algorithms? Pain. 2015;156 (1):104-14.
  • 17. Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Ağrı.The Journal Of The International Association for the Study of Pain. 5 Aralık 2005; 118 (3): 289-305.
  • 18. Obata H. Analgesic Mechanisms of Antidepressants for Neuropathic Pain. Int J Mol Sci. 2017;18(11):2483.
  • 19. Szczudlik A, Dobrogowski J, Wordliczek J, Stepien A, Krajnik M, Leppert W, et al. Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society - Part One. Neurol Neurochir Pol. 2014; (48):262-271.
  • 20. Mendlik MT, Uritsky TJ. Treatment of neuropathic pain. Curr Treat Options Neurol. 2015;17(12):50.
  • 21. Toth C. Pregabalin: latest safety evidence and clinical implications for the management of neuropathic pain. Ther Adv Drug Saf. 2014;5(1):38-56.
  • 22. O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of the latest guidelines. Ben J Med. 2009; 122: S22–32.
  • 23. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. ;2013(8):1-79.
  • 24. Mu A, Weinberg E, Moulin DE, Clarke H. Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician. 2017;63(11):844-852.
  • 25. Kayaalp OS. Akılcıl Tedavi Yönünden Tıbbi Farmakoloji cilt 2. 13. Baskı.Ankara, Pelikan yayınevi,2021.
  • 26. Peng PW, Tumber PS, Gourlay D. Perioperative pain management of patients receiving methadone therapy. Can J Anaesth. 2005; 52 (5): 513–23.
  • 27. Schwartz S, Etropolski M, Shapiro DY, Okamoto A, Lange R, Haeussler J. Safety and efficacy of tapentadol ER in patients with painful diabetic peripheral neuropathy: results of a randomized-withdrawal, placebo-controlled trial. Curr Med Res Opin. 2011; 27 (1): 151–62.
  • 28. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1:1-60.
  • 29. Lakhan SE, Velasco DN, Tepper D. Botulinum Toxin-A for Painful Diabetic Neuropathy: A Meta-Analysis. Pain Med. 2015;16(9):1773-80.
  • 30. Ranoux D, Attal N, Morain F, Bouhassira D. Botulinum toxin type A induces direct analgesic effects in chronic neuropathic pain. Ann Neurol. 2008;64(3):274-83.
  • 31. Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, Furlan A, Gilron I, Gordon A, Morley-Forster PK, Sessle BJ, Squire P, Stinson J, Taenzer P, Velly A, Ware MA, Weinberg EL, Williamson OD; Canadian Pain Society. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328-35.
  • 32. Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018;3(3):1-90.
  • 33. Collins S, Sigtermans MJ, Dahan A, Zuurmond WW, Perez RS. NMDA receptor antagonists for the treatment of neuropathic pain. Pain Med. 2010;11(11):1726-42.
There are 33 citations in total.

Details

Primary Language Turkish
Subjects Neurology and Neuromuscular Diseases
Journal Section Review
Authors

Hacer Sinem Büyüknacar 0000-0002-2893-0037

Figen Amber Çiçek 0000-0001-9640-3522

Hatice Çatalbaş Kozan 0009-0004-6823-8207

Publication Date June 30, 2024
Submission Date April 25, 2024
Acceptance Date June 26, 2024
Published in Issue Year 2024 Volume: 33 Issue: 2

Cite

AMA Büyüknacar HS, Çiçek FA, Çatalbaş Kozan H. Nöropatik Ağrıda Farmakolojik Yaklaşımlar. aktd. June 2024;33(2):106-111. doi:10.17827/aktd.1472782