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Pharmacological management of neuropathic pain in patients with vestibular schwannomas:Experience of the Atlantic Lateral Skull Base Clinic

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World Journal of Pharmacology 2014年第2期3卷 24-32页

作者： Andrea LO Hebb Jana Sawynok Manohar Bance Simon Walling Ken Chisholm David P Morris Atlantic Lateral Skull Base Clinic Division of Neurosurgery Dalhousie University QEII Halifax Infirmary SiteHalifax NS B3H 3A7 Canada Capital District Health Authority QEII Halifax Infirmary Site 3~rd Floor Division of NeurosurgeryHalifax NS B3H 3A7 Canada Department of Pharmacology Dalhousie UniversityNova Scotia B3H 4R2 Canada Division Otolaryngology Dalhousie University QEII Health Sciences CentreHalifax NS B3H 2Y9 Canada Division of Neurosurgery Dalhousie UniversityHalifax Infirmary Site QEII Health Sciences CentreHalifax NS B3H 3A7 Canada Department of Anesthesia and Pain Management Dalhousie UniversityHalifax NS B3H 2Y9 Canada

Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve(eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result incompression and/or irritation of the fifth cranial nerve(trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.

关键词： Acoustic neuroma stereotactic radiothera-py Tricyclic antidepressants Serotonin-norepinephrine reuptake inhibitors Calcium channel modulators Tra-madol Opioids

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