Therapie
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This article reviews the peripheral and central mechanisms of neuropathic pain. The main mechanisms involved in neuropathic pain are: (1) ectopic activities, (2) ephapses, (3) sensitization of nociceptors. Central morphological alterations could also be involved: (1) medullar neuronal reorganization, (2) hyperexcitability of central nervous system nociceptive neurones. The relative resistance of these neuropathic pains to opioid drugs could be related to a decrease in the number of opioid receptors to an amino acid mediator related spinal neurons hyperexitability and to an increase in non opioid peptides such as cholecystokinin.
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Acute pain can be managed favourably by the use of paracetamol, non steroidal anti-inflammatory drugs, opioids and local anaesthetics, solely or in combination. Sophisticated methods of administration such as nerve blocks or patient-controlled analgesia will improve results. ⋯ The role of opioids in the treatment of chronic non-cancer pain has still not been clarified. Adjuvant drugs are often required.