신경병성 통증의 임상

Abstract

The terminology used to describe neuropathic pain has developed over a considerable number of years. Although there have been attempts to formalized it, there remains some degree of confusion, several of the terms being employed inconsistently or interchangeably. Pain or the sensitivity to painful stimuli is described as neuropathic if it is causally related to peripheral or central nervous system structural and/or functional changes resulting from physical injury or disease; it has been suggested that, in practice, neuropathic pain may be differentiated from other type pain in its rapid resolution following intravenous lidocaine. Neuropathic pain may be continuous or paroxysmal; it may also be spontaneous, occuring in the absence of any obvious externally applied stimulus, or it may occur only when evoked, usually by mechanical or thermal; Neuropathic pain usually associated with the characteristic clinical features such as allodynia or hyperalgesia. Allodynia is the term applied when pain occurs to stimuli of a type or intensity that would not normally elicit pain. It is appropriate to refer to hyperalgesia if sensitivity to a stimulus that would normally be expected to produce pain is markedly greater than one would expect; Neuropathic pain has been classified according to the site of initial injury. This may be peripheral, as in the case of painful polyneuropathies or mononeuropathies, the latter embracing lancinating neuralgias, activation of nociceptive nervi nervosum, and activity arising in neuromas, or it may be central, as exemplified by deafferentation pain or pain arising from thalamic strokes or spinal cord injury. Mixed peripheral and central sites are involved in sympathetically maintained pain states and in acute herpetic and postherpetic neuralgias; the management of neuropathic pain is frequently found to be difficult, and this is reflected in the wide range of treatments that have been, and in many cases still are employed clinically. These include various forms of drug therapy, nerve block, and transcutaneous electrical stimulation.