La Revue du praticien
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La Revue du praticien · Jun 2013
Review[Pharmacological treatment of neuropathic pain in primary care].
Neuropathic pain is difficult to treat. First line treatment includes tricyclic antidepressants (notably amitriptyline), mixed serotonin and norepinephrine reuptake inhibitors (duloxetine for diabetic peripheral neuropathic pain), antiepileptics (gabapentin and pregabalin) and topical agents (lidocaine plasters for postherpetic neuralgia). These drugs can be subsequently associated in case of partial response to monotherapy. Opioids and tramadol are only considered second/third line, alone or in combination with first line drugs.
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La Revue du praticien · Jun 2013
Review[Pathophysiology of chronic pain. Classification of three subtypes of pain].
Pain is a physiological sensation which aim is to alert for an upcoming danger that may threaten the individual. This system includes peripheral nociceptors that initiate the nociceptive message. Then, the information is conveyed to the brain through the spinothalamic tract that projects to the thalamus, insula, SII and other areas. ⋯ This is the neuropathic pain. Case 3: between the two former cases, there is no evidence for a lesion in the nociceptive system, and there are no evidences for lesion at the peripheral level, but there are evidences of dysregulation(s). These are the cases of dysfunctional pain.
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The pharmacological treatment of chronic pains induced by an excess of nociception is mainly based on analgesics which are classified according to their pharmacological nature (not opioid/opioid) and to their power according to the three World Health Organization steps. Their use is founded on a strategy which differs from the nature of pain (cancer pain vs no cancer pain), in particular with regard to the use of the strong opioids.
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The chronic pain management structures were identified by the French health authorities regarding two levels: consultation (with a pluri-professional organization and proximity missions) and the center (with a multidisciplinary organization and expertise). Access to these structures is facilitated by guidelines published in 2008 by the Haute Autorité de santé.