แนวทางเวชปฏิบัติภาวะปวดเหตุพยาธิสภาพประสาท (Clinical practice guideline for neuropathic pain), แหล่งข้อมูล: http://www.pmh.go.th/index.php?option=com_content&view=article&id=1719:-clinical-practice-guideline-for-neuropathic-pain-&catid=50:km&Itemid=115

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(Clinical Practice Guideline for Neuropathic Pain)
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ISBN: 978-974-598-056-3
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(Clinical Practice Guideline for Neuropathic Pain)
¿“«–ª«¥‡Àµÿ欓∏‘ ¿“æª√– “∑
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ISBN: 978-974-598-056-3
(Clinical Practice Guideline for Neuropathic Pain)
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ISBN: 978-974-598-056-3
พิมพ์ค ้งที่ 1
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บียอนด์ เอ็นเทอร์ไพรซ์, กรุงเทพฯ

5. Neuropathic pain
”
“
“
”
(general practitioners)
“
”
.
.
ก

6. 1.
. .
2.
. .
3.
. . .
4. . .
5. . .
6. . .
7. .
8. . .
9. . .
10. . .
11. .
12. .
13. . .
14.
.
15.
.
ข

7. สารบัญ
คำนำ
รายนามคณะผู้จัดทำ
ข้อแนะนำการใช้ CPG
วิธีการสืบค้นข้อมูล
บทที่ 1 บทนำ
1.1 ลักษณะอาการปวดเหตุพยาธิสภาพประสาท
1.2 ระบาดวิทยา
บทที่ 2 การวินิจฉัย เครื่องมือ และวิธีติดตามภาวะปวดเหตุพยาธิสภาพประสาท
บทที่ 3 การรักษาภาวะปวดเหตุพยาธิสภาพประสาท
3.1 การรักษาโดยการใช้ยา
3.2 การรักษาโดยการผ่าตัด
3.3 การรักษาโดยเวชศาสตร์ฟื้นฟู การแพทย์ผสมผสาน และ การแพทย์ทางเลือก
บทที่ 4 การวินิจฉัย และรักษาภาวะปวดเหตุพยาธิสภาพประสาทในโรคที่จำเพาะ
4.1 Diabetic peripheral neuropathy
4.2 Post herpetic neuralgia
4.3 Trigeminal neuralgia
4.4 Phantom limb pain
4.5 Central pain
4.6 อื่นๆ
บทที่ 5 เกณฑ์การส่งต่อผู้ป่วย
ภาคผนวก 1 คุณภาพหลักฐาน (Quality of evidence)
ภาคผนวก 2 หลักการกำหนดน้ำหนักคำแนะนำ
ภาคผนวก 3 แนวทางการใช้ระดับหลักฐานประกอบการกำหนดน้ำหนักคำแนะนำ
ภาคผนวก 4 ลักษณะของความปวดและการตรวจร่างกาย
ภาคผนวก 5 เครื่องมือที่ใช้ในการวินิจฉัยและคัดกรอง
ภาคผนวก 6 แบบสอบถาม Thai DN4
บรรณานุกรมและเอกสารแนะนำเพิ่มเติม
ค
หน้า
ก
ข
ง
ฉ
1
1
2
3
7
7
12
15
20
20
22
23
24
25
26
27
28
29
32
33
35
36
37

8. CPG
CPG
++
CPG
CPG
(Strength of Recommendation)
(cost effective) “
+
+/-
“
”
“
”
-
--
”
“
”
“
”
(Classification of references)
Level of evidence A
systematic review
randomized,
controlled clinical trials
randomized, controlled
clinical trials
Level of evidence B
systematic review
controlled clinical
study
controlled clinical study (
nonrandomized, controlled trial, cohort study, case-control study,
cross sectional study)
ง

9. randomized, controlled clinical trials
randomized, controlled clinical trials
systematic review
randomized, controlled clinical trials
randomized, controlled clinical trials
Level of evidence C
systematic review
descriptive study
descriptive study
systematic review
controlled clinical study
controlled clinical study
controlled clinical trials
Level of evidence D
(consensus)
: Level of evidence (
. .- . . 2544)
18
จ
6

10. /
Medline, Cochrane library, EMBASE
1966
2008
neuropathic pain, epidemiology, assessment,
treatment, diagnosis, guideline, rehabilitation, complementary medicine, alternative
medicine, acupuncture, central pain, post herpetic neuralgia, trigeminal neuralgia, diabetic
peripheral neuropathy
key articles
ฉ

11. 1
1.1
Neuropathic pain
somatosensory system
(lancinating)
(burning)
(pins and needles) (itching)
(paresthesia)
(stimulus- independent pain
spontaneous pain)
(stimulus- dependent pain
stimulus-evoked pain)
(tingling)
allodynia
hyperalgesia
Neuropathic pain
neuropathic pain
HIV
neuropathic pain
(mixed pain)
neuropathic pain
neuropathic pain
diabetic neuropathy, multiple sclerosis
Association for the Study of Pain
“
neuropathic pain
neuropathic pain
neuropathic pain
. . 1994 International
neuropathic pain
”1
somatosensory pathways
spino-thalamocortical system
1

12. “
”
2
neuropathic pain
neuropathic pain
. . 2007
2nd Congress of Neuropathic Pain
“
somatosensory system”
(Pain arising as a direct consequences of disease affecting the somatosensory system)3
(plasticity)
neuropathic pain
4
(hyperexcitability)
neuropathic pain
1.2
neuropathic pain
multiple sclerosis
post herpetic neuralgia
spinal cord injury
post mastectomy syndrome
amputation
pain sciatica
neuropathic pain
6.8-8.25, 6
phantom pain
low back
37.8-48
7, 8
369
herpetic neuralgia
10-1510
pain
54.712
stroke pain
813 multiple sclerosis
13- 38 15, 16, 17
neuropathic pain
18
syndrome
20
Neuropathic pain
neuropathic pain21, 22
2
post
low back
post
16-2611
27.514
post mastectomy
19
20

13. 2
neuropathic pain
(pathognomonic sign)
neuropathic pain
(neuroanatomy)
(
2.1
nociceptive, neuropathic, psychogenic
neuropathic pain
2.1)

14. 2.1
(
(
DN4
6)
DN4
4, 5
4)
(
6)
Thai
+
1.
2.
++
++
3.
++
4.
,
,
5.
6.
+
,
1
3-6
1
++
+
+
2
Neuropathic pain
(
visual analog scale
neuropathic pain
)
numerical rating scale
4
++
+/+

15. NEUROPATHIC PAIN
Possible
History of relevant
disease or lesion in
the nervous system
Pain in neuroanatomical area
Probable
Decreased sensibility in
painful area
Definite
Document of nerve
lesion
Decreased sensibility
in painful area
History of relevant
disease or lesion in the
nervous system
Pain in neuroanatomical area
History of relevant
disease or lesion in
the nervous system
Pain in neuroanatomical area
neuropathic pain1
2.1
neuropathic pain
neuropathic pain
(
2.1)
Neuropathic Pain Scale (NPS)2, Neuropathic Pain
Questionnaire (NPQ)3, NPQ short form4, Neuropathic Pain Symptom Inventory (NPSI)5, ID
LANSS Pain Scale9 (
5)
Pain6, DN47, PainDetect8
6)
neuropathic pain
DN410 ( Thai DN4
(quantitative)
(qualitative)
spontaneous ongoing pain, spontaneous paroxysmal pain,
paresthesia
(evoked pains)
allodynia
dysesthesia
hyperalgesia
1. Visual analogue scale (VAS)
11
VAS
10
5

16. (
2.2 A)
2. Numerical rating scale (NRS)
worst possible pain) (
2.2 B)
3. Verbal rating scales (VRS)
2.2 C)
4. Wong-Baker faces pain rating scale
3
11-point Likert scale (0 = no pain, 10 =
(
numerical rating scale
2.2 D)
(
A
B
0
C
1-3
0
1
2
3
7-10
4-6
4
5
6
7
8
9
10
D
2.2
A: Visual analogue scale (VAS), B: Numerical rating scale
(NRS), C: Verbal rating scales (VRS), D: Wong-Baker faces pain rating scale

17. (
2.3)
2.3
Quantitative Sensory Testing (QST)
allodynia
hyperalgesia

18. *
?A
first-line drug
first-line drug
1
?B
1)
(
first-line
?C
(
second-line
3.1)
first-line drug
*
Average pain score
B Average pain score
C Average pain score
4-8
A
VAS
VAS
VAS
NRS
NRS
NRS
3/10
4/10
30%
4-8

19. 3.1
neuropathic pain
1. First-line medications
1.1 Tricyclic antidepressants
Amitriptyline
-
Enhance
descending
inhibitory
pain pathway
10-75
./
++
--
+
-
75
./ )
-
--
+
++
200-1200
./
+
-
300-1800
./
+
-
10-25
.
25 .
1-2
Nortriptyline
Imipramine
1.2 Calcium channel 2 1 ligands
- Gabapentin
Block 2
subunit of
calcium
channel
1
,
,
anticholinergic,
anticholinergic*
10-
(
,
300-3600
./
100300 .
300
3-7
100.
2-4
1.3 Sodium channel blockers
Carbamazepine
-
*
10
Oxcarbazepine
Block sodium
channel
anticholinergic
10

20. 3.1
neuropathic pain
2. Second-line medications
2.1 Tramadol
50-400
-Weak
agonist
./
-
-Enhance
descending
inhibitory pain
pathway
agonist
2.2 Oral morphine
-
( )
+
SSRIs
SNRIs
-
+/-
SSRIs
SNRIs
TCAs
+
+/-
tramadol
2.3 Methadone
-
agonist
NMDA
antagonist
+
+/-
tramadol
morphine
2.4 Pethidine
neuropathic pain
agonist
2.4 Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
Venlafaxine
75-150 ./
Enhance
descending
Inhibitory pain
pathway
-
Duloxetine*
2.5 Calcium channel 2
- Pregabalin
30-60
1
ligands
Block 2
subunit of
calcium
channel
1
75-600
+
serotonin
syndrome
./
,
,
chronic neuropathic pain
: Duloxetine
31
+/-
+
+/-
+
++
tramadol
./
2.6 Paracetamol, NSAIDs,
COX-2 inhibitors
*
--
--
2549
11
11

21. 3.2
neuropathic pain
Burning
TCA
SNRI
Sodium channel
blockers
Calcium channel
2 1 ligands
Opioids
3.3
Amitriptyline
Venlafaxine
Duloxetine
Carbamazepine
Oxcarbazepine
Gabapentin
Pregabalin
Tramadol
Morphine
Lancinating
++
+
++
+/+/++
++
+
+/-
+/+/+/++
++
+/+/+/+/-
neuropathic pain
Hyperalgesia Allodynia
++
+
++
+
+
++
++
+
+/-
++
+
+
+
+
++
++
+
+/-
Paresthesia,
dysesthesia
+
+/+/+
+
+
+
+
+/-
neuropathic pain
neuropathic pain
DPN
PHN
TGN
Phantom Central pain
limb pain
TCA
Amitriptyline
++
++
+/+
++
SNRI
Venlafaxine
+
+
+/Duloxetine
++
+
+/Sodium channel
Carbamazepine
+/+/++
+
+
blockers
Oxcarbazepine
+/+/++
+
+
Calcium channel
Gabapentin
++
++
+/+
+
Pregabalin
++
++
+/+
+
2 1 ligands
Opioids
Tramadol
+
+
+/+/Morphine
+/+/+/+/DPN: diabetic peripheral neuropathy, PHN: post herpetic neuralgia, TGN: trigeminal neuralgia
12

22. 3.2
3.4
Trigeminal neuralgia
neuropathic pain
1.
Microvascular decompression
(MVD)
2.
3.
1.
++
68-95%
70 – 95%
72 – 73%
vascular loop
compression
5-6
0.1%
1%
Gamma knife
+/-
2.
47 – 88 %
(75 – 92.9 %
24 – 74 %
18
90% )
10%
SRS
1
1 )
3 ( 48 –
persistent paresthesia (
15.8%
16.3%
Radiofrequency
thermoregulation
+
83 – 97%
49 – 70%
5-7
Motor cortex stimulation
+/-
Dorsal root entry zone
(DREZ) dressing
+/-
Spinal cord stimulation
Motor cortex stimulation
+/+/-
10%
42%
,
, 35%
, 13%
36%
Post herpetic neuralgia
1.
2.
DREZ spinal
cord stimulation (60-70% for
DREZ)
13

23. 3.4
Phantom limb pain
neuropathic pain
1.
2.
( )
Dorsal root entry zone
(DREZ) lesion
+/For general
-Stump pain
Deep brain stimulation (DBS)
traumatic
amputations associated with root
avulsion
phantom
stump pain
stump pain
+/DBS PVG/PAG grey matter
(79%)
PVG/PAG plus
sensory thalamus/internal
capsule (87%)
sensory thalamus
(58%
long-term success) (p 0.05)
DBS
nociceptive
pain
deafferentation pain
(63% vs 47% long-term success;
p 0.01)
3.
neuroma
+
+/-
Thalamic pain
1.
Deep brain stimulation
+/-
Trial stimulation
50%
post-stroke pain
2.
58%
Motor cortex stimulation
+/-
10%
, 42%
, 35%
, 13%
36%
Causalgia, Sympathetic
mediated pain
1.
2.
14
Sympathectomy
+
sympathetic
block
66-96%
94%
sympathectomy

24. 3.3
Neuropathic pain
neuropathic pain
1.
2.
2
1
neuropathic pain
RCT
(adjunctive therapy)
15
15

25. 2,3
3.3.1
5
(acupuncture)
neuropathic pain
alternative medicine
40
36
3.5
3.5
/
Patient education
TENS (Transcutaneous
Electrical Nerve
Stimulation)
- Hi-TENS (conventional)
Hi frequency, low
intensity
- Lo-TENS (acupuncturelike)
Lo frequency,
Hi intensity
++
Chronic neuropathic
pain
pacemaker
cardiac
-
4,5,6,7
9
200
-
(
+
)
-
+/-
allodynia
-Hi-TENS
TENS
,
Lo-TENS
8
-
/
-
30
Hi-TENS
Lo-TENS
trial
error
accommodation
effects of nerve
nerve fiber
16
16
-Hi-TENS
cardiac
pacemaker

26. 3.5
( )
/
Relaxation techniques
Neuropathic pain:
Postherpetic neuralgia
peripheral
neuropathy
-
-
+
-
General Exercise
improve general condition
7,8,17
6,7
++
(immobilization
syndrome)
Specific exercise
Heat Cold hot
pack, warm bath, ice
+/Neuropathic pain
-
burn
sensory impaired
-
7
+/--
Desensitization
Neuropathic pain
-
allodynia
-
9
sensory deficit
DM
+/-allodynia
(
)
17

27. 3.3.2
Alternative Medicine: CAM)
peripheral neuropathy
(mega-vitamins
35)
(magnet
10
(
22)
chiropractor (
21)
(Complementary
43
CAM
30)
(
30)
27
3.6
CAM
neuropathic pain
18
18

28. 3.6
/
(Acupuncture)
Painful diabetic
neuropathy, central
neuropathic pain in
spinal cord injury
(SCI)
-RCT
(postherpetic neuralgia)
placebo,
sham,
painful
diabetic neuropathy, central
neuropathic pain in SCI
-
-
hepatitis B
HIV,
Painful peripheral
neuropathy
10,14
1-3
(10
4-5
/
(
-
6,10
neuropathic pain
(balanced
1
)
B6
neuropathy
)
Mild degree
neuropathic pain
+/Central NeP
(SCI)
painful
diabetic neuropathy
post-herpetic
neuralgia
)
neuropathic pain
diet)
-
+/radiculopathy
trigeminal neuralgia
1,6,12,13
-
(
5,8,11
peripheral
sensitization
-
+
Balanced diet
++
Avoid alcohol
+/MTV, B complex, 3B
-B6
100 ./ )
-Vitamin E 400
U/day
Parkinson’
disease
Alzheimer’s disease
+/-
19
19

29. 4
4.1 Diabetic neuropathy
1
2
2
1
13.12
32.33
5
20-33%
10
4
7-13
4
3
1. Distal symmetric diabetic polyneuropathy (DSDP)
/
2. Autonomic neuropathy
(autonomic neuropathy)
DSDP
20
20
2

30. QT
3. Focal and multifocal neuropathy
median, radial, ulnar
peroneal nerve
truncal radiculoneuropathy,
(entrapment)
,
(hyperglycemia)
species)
polyol pathway
(reactive oxygen
(advanced glycation endproducts
AGEs)
protein kinase C
6
2
glucose tolerance test
serum electrophoresis, TSH, BUN, Creatinine
(skin biopsy)
7
Quantitative sensory testing (QST)
21
21

31. :
reductase inhibitors
8,9
aldose
nerve growth factor
:
(focal or multifocal neuropathy)
(carbamazepine, gabapentin, pregabalin),
antidepressant
10
(amitryptyline, nortryptyline, duloxetine)
opioid
tramadol
strong opioid
11
topical capsaicin
12
0.075%
neuropathic pain
fludrocortisone
midodrine
13
4.2
(Post herpetic neuralgia, PHN)
varicella-zoster
1,000
2.2-3.4
1
20
(dermatome)
(post herpetic neuralgia)
2
72
acyclovir, valacyclovir
22
22
famciclovir
1-3
PHN

32. PHN1,2
PHN3
amitryptyline
2
PHN
4
PHN
gabapentin
TCAs
tramadol
4.3
pregabalin
1,5
(Trigeminal neuralgia or Tic douloureux)
5.9
3.4
5
100,000
5
(trigger point)
trigeminal ganglion
(sensory function)
3 (V2,V3)
1 (V1)
2
1
loop
demyelination
MRI brain
multiple sclerosis
600-1,200
arterial
5
venous
meningioma
100
.
.
carbamazepine
2-3
23
23

33. oxcarbazepine
baclofen, phenytoin, gabapentin, lamotrigine
1-3
(2)
ganglion
alcohol
micro vascular loop decompression (MVD)
Gamma
4
knife radiosurgery
5
MVD
4.4
(Phantom limb pain)
1, 2
phantom sensation
acute just post amputation pain
chronic residual limb pain
phantom phenomena
60-80
(phantom pain)
5-10
(stump pain)
24
(nerve block)
24

34. (randomized control trial)
(neuropathic pain)
(non invasive
treatment)
sodium channels
(antidepressants)
calcium channels
opioids
randomized controlled trials
tricyclic
meta analysis
4.5 Central neuropathic pain
8
40
spinothalamic pathway
neuronal excitability
central neuropathic pain
trial
randomized controlled
1. Central neuropathic pain, post stroke : TCA
pregabalin
2. Spinal cord injury pain: calcium channel 2 1 ligands
3. Pain associated with multiple sclerosis: cannabinoids (level B)
4. Central neuropathic pain
: pregabalin, TCAs, lamotrigine, gabapentin (level B)
25
25

35. first
second line
peripheral neuropathic pain
4.6
(mixed pain)
neuropathic pain
neuropathic pain
neuropathic pain
neuropathic pain
Cancer pain: neuropathic pain
opioids
SNRIs
gabapentin, pregabalin, TCAs,
antiepileptics
Painful polyneuropathy
o HIV neuropathy
antiretrovirals
CYP450
CYP450
gabapentin
o Drug-induced neuropathy
o Guillain–Barre syndrome
gabapentin
carbamazepine
opioids
Nerve injury pain
radicular pain (include back pain), post-traumatic/postsurgical neuropathic pain
complex regional pain syndromes (CRPS)
paracetamol
neuropathic pain
NSAIDs
neuropathic pain
neuropathic pain
26
26

36. 5
neuropathic pain
1.
2.
/
neuropathic pain
3
3.
4.
5.
(chronic pain)
first-line drugs
(chronic pain syndrome)
5.1
7/10
50
2
strong opioids
invasive techniques /
1
/
5.2
5.3
5.4
5.5
5.6
5.7
27
27

37. 1
(Quality of Evidence)
1
1.1
(systematic
(randomize-controlled clinical trials)
1.2
randomize-controlled, clinical trial)
review)
1
(a well-designed,
2
2.1
(non-randomized, controlled,
clinical trials)
2.2
(well-designed, non-randomized, controlled
clinical trial)
2.3
(cohort)
(case control analytic studies)
/
(multiple time series)
2.4
. .
2480
3
4
3.1
3.2
(descriptive studies)
(fair-designed, controlled clinical trial)
4.1
(consensus)
4.2
2
(anecdotal report)
28
28

38. 2
“
(strength of recommendation)”
(prolonged life)
(improved quality of life)
(decreased morbidity)
(
/
)
“
1
“++”
”
“++”
1
(
“+/-”)
50
Papanicolaou
2
“++”
CT / MRI brain
“++”
(
“+/-”)
1.
“+/-”
:-
2.
3.
4.
29
29

39. 5.
12
(systematic
review
and
consensus of peer reviewers)
/
“5 ”
(1)
(2)
/
(3)
(
)
“5 ”
(1)
(2)
(3)
(4)
(5)
1.
(safety)
(efficacy)
(effectiveness)
(benefit of population and entire society)
(efficiency)
(safety)
monitoring program: SMP)
harm)
2.
(
(safety
NNH: number needed to
(efficacy)
/
30
30

40. (
needed to treat)
3.
NNT:
number
(effectiveness)
/
/
/
3.1
3.2
3.3
3.4
4.
(benefit of population and entire society)
(utility)
5.
/
(efficiency)
4
31
31

41. 3
:“++”,
1.
/
1.1.
“--”
/
(
2
1 :
:-
-
)
(randomize-controlled, clinical trial)
1
1.2.
2 :
(non-randomized, controlled, clinical trial)
2
1.2.1.
1.2.2.
1.2.3.
(cohort)
(case-control)
(multiple-time series)
“+”,
2.
“-”
/
1
/
(
(
2.1.
adrenaline
)
)
/
/
:1(
1
2.2.
1
3
/
,
2
2
)
4
“+/-”
3.
(
)
3.1.
(
)
3.1.1.
3.1.2.
3.1.3.
3.1.4.
3.1.5.
3.2.
3.3.
3.4.
3.5.
:-
(surrogated end-point)
(safety monitoring program : SMP)
.
(
1
/
2)
.
(ultimate end points)
32
32

42. 4
Neuropathic pain
2
1.
(stimulus-independent
spontaneous pain)
(burning)
(intermittent shooting),
(lancinating sensations),
(electric shock-like pain)
(tingling)
“paresthesias”
“dysesthesias”
2.
(stimulus-dependent
stimulus-evoked pain)
“Hyperalgesia”
(mechanical)
(thermal)
(chemical)
“Allodynia”
Mechanical allodynia
(
1A)
Thermal allodynia
40
(
neuropathic pain
2)
(
1.
2.
3.
4.
1B)
(pinprick sense)
(tuning fork)
128-Hz
33
33

43. 1
A
B
2
34
neuropathic pain

44. 35
Assess
distinct
qualities of
NeP
10
NeP = neuropathic pain
Intended use Patient
administered
Type
Number of
Questions
Question /
pain
descriptor
NPS2
Patient
administered
Discriminate
between
NeP and
Non-NeP
12
NPQ3
Patient
administered
Screen NeP
3
NPQ Short
Form4
neuropathic pain
Patient
administered
Identify NeP
7
NPSI5
Patient
administered
Screen NP
6
ID PAIN6
Patient
administered
Screen NP
7
DN4 for
patients7
Patient
administered
Screen NP
component
in LBP
9
Pain
DETECT8
Patient
administered
Identify NeP
7
LANSS for
patietns9
Physician
administered
Discriminate
NeP from
Non-NeP
10
DN4 for
physicians7
Physician
administered
Identify NeP
7
LANSS for
physician9
5
35

45. 6
Thai DN4
1.
?
1.
2.
3.
2.
?
4.
5.
6.
7.
3.
8.
9.
4.
10.
=1
=0
4
_______/10
neuropathic pain
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36
36

46. 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
1.
2.
3.
4.
5.
6.
7.
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15.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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14. Chong MS, Bajwa ZH. Diagnosis and treatment of neuropathic pain. J Pain Symptom Manage 2003; 25:S4-S11.
4.
1.
2.
3.
4.
5.
4.1 Diabetic peripheral neuropathy (DPN)
Kulkantrakorn K. Diabetic neuropathy: new insights and treatments. Intern Med J Thai 2005;21:286-91.
Tapp RJ, Shaw JE, de Courtenm MP, Dunstan DW, Welborn TA, Zimmet PZ, et al. Foot complications in type 2 diabetes: an
Australian population-based study. Diabet Med 2003; 20:105-13.
Fedele D, Comi G, Coscelli C, Cucinotta D, Feldman EL, ChirlandaG, et al. A multicenter study on the prevalence of diabetic
neuropathy in Italy. Diabetes Care 1997; 20:836-43.
Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M. Natural history of peripheral neuropathy in patients with
non-insulin-dependent diabetes mellitus. N Engl J Med 1995; 333:89-94.
Sriussadaporn S, Mekanandha P, Vannasaeng S, Nitiyanant W, Komoltri C, Ploybutr S, Yamwong P, Peerapatdit T, Vichayanrat A.
Factors associated with diabetic foot ulceration in Thailand: a case-control study. Diabet Med 1997; 14:50-6.
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49. 6.
7.
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11.
12.
13.
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
1.
2.
3.
4.
1.
2.
3.
4.
Yagihashi S, Yamagishi S, Wada R. Pathology and pathogenetic mechanisms of diabetic neuropathy: correlation with clinical signs
and symptoms. Diabetes Res Clin Pract 2007; 77:S184-89
Lauria G, Lombardi R. Skin biopsy: a new tool for diagnosing peripheral neuropathy. BMJ 2007; 334:1159-62.
Gabbay KH. Aldose reductase inhibition in the treatment of diabetic neuropathy: Where are we in 2004? Curr Diab Rep 2004; 4:4058.
Pittinger G, Vinik A. Nerve growth factor and diabetic neuropathy. Exp Diabesity Res 2003; 4:271-85.
Casellini CM, Vinik AI. Clinical manifestations and current treatment options for diabetic neuropathies. Endocr Pract 2007; 13:550-66.
Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GS, et al. Advances in neuropathic pain: diagnosis,
mechanism and treatment recommendations. Arch Neurol 2003; 100:1524-34.
Nolanoa M, Simoneb DA, Wendelschafer-Crabb C , Johnsonc T, Hazenc E, Kennedyc WR. Topical capsaicin in humans: parallel
loss of epidermal nerve fibers and pain sensation. Pain 1999; 81:135–145.
Vinik A, Ullal J, Parson HK, Casellini CM. Diabetic neuropathies: clinical manifestations and current treatment options. Nat Clin Pract
Endocrinol Metab 2006; 2:269-81.
4.2 Post herpetic neuralgia (PHN)
Pavan-Langston D. Herpes zoster antivirals and pain management. Ophthalmology 2008: 115:S13-S20.
Opstelten W, EekohoF J, Neven AK, et al . Treatment of herpes zoster. Can Fam Physician 2008; 54:373-377
He L, Zhang D, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2008;
1:CD003582.
Johnson R, McElhaney J, Pedalino B, Levin M. Prevention of herpes zoster and its painful debilitating complications. Int J Infeut Dis
2007; 11:S43-S48.
Tyring SK. Management of herpes zoster and posterpetic neuralgia. J Am Acad Dermatol 2007; 57:S136-S142.
4.3 Trigeminal neuralgia (TGN)
Cheshire WP. Trigeminal neuralgia : for one nerve a multitude of treatments. Expert Rev Neurother 2007; 7:1565-79.
Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management of trigeminal neuralgia. Br J Neurosurg 2007;
21:253-61.
Hunt K, Patwardhan R. Trigeminal neuralgia: a modern-day review. Int Rev Neurobiol 2007; 76:621-31.
Guo S, Chao ST, Reuther AM, Barnett GH, Suh JA. Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery.
Sterotact Funct Neurosurg 2008; 86:135-146.
Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long term
outcomes. Acta Neurochir (Wien) 2008; 150:243-55.
4.4 Phantom limb pain
Nikolajsen L, Jensen TS. Phantom pain. In: McMahon SB, Koltzenburg M, eds. Wall and Melzack’s textbook of pain, 5th ed. China:
Elsevier, Churchill Livingstone, 2006:961-72.
Sherman RA. Postamputation pain. In: Jensen TS, Wilson PR, Rice ASC, eds. Clinical pain management: Chronic pain, 1st ed.
London: Arnold, 2003, 427-36.
Woodhouse A. Phantom limb sensation. Clin Exp Pharmacol Physiol 2005; 32:132-4.
Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol 2002; 1:182-9.
4.5 Central pain
Vranken JH , Dijkgraaf MGW., Kruis MK , van der Vegt MH, Hollmann MW, Heesen M. Pregabalin in patients with central
neuropathic pain: A randomized , double – blind , placebo - controlled trial of a flexible - dose regimen . Pain 2008;136:150-157.
Dworkin RH, O’ Connor AB, Backonja M, et al . Phamacologic management of neuropathic pain: Evidence-based recommenddations. Pain 2007; 132:237-51.
Finnerup NB, Jensen TS. Spinal cord injury pain : mechanisms and treatment. Eur J Neurol 2004;11:73-82
Finnerup NB, Otto M, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment : an evidence based proposal. Pain 2005;
118:289-305.
5. Referral criteria
1. Argoff CE, Backonja MM, Belgrade MJ, Bennett GJ, Clark MR, Cole BE, et al. Consensus Guidelines: Treatment Planning and
Options. Mayo Clin Proc 2006;81(Suppl 4):S3-S11.
40
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