文獻回顧：中風後中樞性神經痛之非侵入性治療

Noninvasive treatment of central post-stroke neuropathic pain

中樞性的神經性疼痛為中風的後遺症之一，這種嚴重的疼痛會降低病人在復健上的進步。目前對中樞性神經疼痛並沒有良好的單一治療方法，合併多種治療為普遍建議的做法。由於中風病人在發生初期多採用保守治療，本文回顧中樞性神經疼痛的非侵入性療法。藥物使用以amitriptyline和lamotrigine為第一線藥物。非藥物治療雖有許多選擇，但多數缺乏良好的研究證實其效用，臨床醫護人員應視情況而施予治療。

BACKGROUND: Central post-stroke pain (CPSP) is a neuropathic pain syndrome occurring after a cerebrovascular accident in 8 to 14 % of patients with stroke. This pain is largely refractory to medicinal and surgical treatments. Investigators have assayed numerous types of medicines and therapies for CPSP, but large controlled trials are lacking, and a treatment method is far from being standardized. OBJECTIVE: To review the current pharmacological treatments for CPSP and other noninvasive modality options, and to evaluate the strength of evidence on the efficacies of the treatment forms. METHODS: Search strategies with the keywords 'neuropathic pain,' 'stroke,' and 'central post-stroke pain' were used in combination with 'pharmacological treatment,' 'acupuncture,' 'neurostimulation,' 'physical therapy,' 'modality'and 'transcutaneous electrical nerve stimulation' as treatment options. The retrieved articles relating to CPSP were reviewed. RESULTS: The pathophysiology of CPSP is not well understood, but previous research has suggested central disinhibition, imbalance of stimuli, and central sensitization as underlying mechanisms. Amitriptyline and lamotrigine are recommended as first-line drugs, with mexiletine, fluvoxamine, and gabapentin as second-line drugs. There are numerous non-pharmacological therapies for CPSP, but more extensive research is required to determine their efficacies. CONCLUSIONS: CPSP patients present with diverse sensory symptoms. The pathophysiology of CPSP is still poorly understood; thus, further studies are needed to elucidate the underlying mechanisms and investigate newer therapeutic modalities.