tailieunhanh - Đau thần kinh

Cả hai đều đau nociceptive và đau do thần kinh thường gặp trong các thiết lập chỉnh hình. Trong hầu hết các bệnh nhân, nociceptive đau (ví dụ, sau phẫu thuật cấp tính đau hoặc đau liên quan đến gãy xương) có thể được kiểm soát đầy đủ với các thuốc chống viêm không steroid (NSAIDs), thuốc giảm đau opioid, | Advances in Therapeutics and Diagnostics Gabapentin Richard W. Rosenquist MD Both nociceptive pain and neuropathic pain are commonly encountered in the orthopaedic setting. In most patients nociceptive pain eg acute postoperative pain or pain associated with a fracture may be adequately controlled with nonsteroidal anti-inflammatory drugs NSAIDs opioid analgesics or a combination of these. Neuropathic pain refers to a group of disorders characterized by pain resulting from dysfunction or disease of the nervous system at a peripheral level central level or both. Frequently NSAIDs and opioid analgesics do not provide relief and adequate control requires medications directed specifically at neuropathic pain. Medications commonly used include antispasmodics tricyclic antidepressants and anticonvulsant agents. Anticonvulsant drugs have been used in pain management since the 1960s soon after they were first used in the management of epilepsy. A recent addition to this class of agents is gabapentin. Gabapentin was initially approved by the FDA for use as an adjunct in treating partial seizures with or without generalization. Its safety and efficacy soon led to its use in treating a wide variety of neuropathic pain conditions. It has some distinct advantages over other available medications. As a result gabapentin has rapidly become a first-line agent for the treatment of neuropathic pain. Structure and Mechanism of Action Neuropathic pain is the result of complex pathophysiologic changes occurring at many levels. These changes include increased neuronal excitability and ectopic firing at the site of injury and the dorsal root ganglia. In addition upregulation of sodium channels enhanced sensitivity to mechanical and chemical stimuli proliferation of adrenergic innervation and changes involving calcium signaling affecting synaptic neurotransmitter release contribute to the pathophysiology of neuropathic pain. Gabapentin is a structural analog of gamma-aminobutyric acid .

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