[Neuropathic pain syndromes: from their diagnosis to the return to work. Proposal of a model for rapid evaluation and therapy based on their pathogenic mechanisms].
The therapeutic approach to neuropathic pain differs significantly among physicians. This is in large part because of the relative paucity of randomized clinical trials and the scarcity of comparative studies with different drugs. Clinical studies on the efficacy of a drug or a technique are generally referred to the pathologic diagnosis and not to the pain mechanism. We have learned from animal models the different pain mechanisms which may be involved in the peripheral nerves and the spinal cord. Unfortunately, one mechanism could be responsible for many different symptoms, while the same symptom can be caused by different mechanisms. The authors propose a simple model to evaluate the patients in order to define the mechanisms involved an to select the treatment strategy. The diagnostic model allows classification of the patient into four groups according to pain mechanism (spinal neurons sensitization due to deafferentation, ectopic discharges in peripheral nociceptive C fibers, spinal neurons sensitization due to ectopic discharges in peripheral nociceptive C fibers, spinal neurons sensitization due to nociceptors sensitization). The authors propose also a second step in which a fifth mechanism, adrenosensitivity, is evaluated. Treatment options may target any of the mechanisms discussed. Drugs and analgesic techniques can be classified according to their action on pain mechanisms. The authors identify in the literature some drugs and techniques which can be tested in each defined groups. A complementary and multidisciplinary rehabilitative approach of chronic pain patients is recommended.
Buonocore
M
M
Servizio di Neurofisiopatologia, Fondazione S. Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Pavia.
Bonezzi
C
C
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002422:Causalgia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003000:Clonidine / Q000627:therapeutic use; D004651:Employment; D017408:Guidelines as Topic; D006801:Humans; D009294:Narcotics / Q000627:therapeutic use; D013126:Spinal Nerve Roots
D000316:Adrenergic alpha-Agonists; D000779:Anesthetics, Local; D000928:Antidepressive Agents; D009294:Narcotics; D003000:Clonidine
Sindromi algiche neuropatiche: dalla diagnosi al reinserimento professionale. Proposta di un modello per una rapida valutazione ed una terapia basata sul meccanismo patogenetico.