Nöropatik Ağrı
Özet
Uluslararası Ağrı Çalışmaları Derneği (The International Association fort he Study of Pain= IASP), nöropatik ağrıyı somatosensoriyel sinir sisteminin bir lezyonu veya hastalığı olarak tanımlamıştır. Bir uyarı ile nosiseptörlerin, serbest sinir uçları ile Aδ ve C-lifleri aktive olarak, spinal kord, sonrasında santral sinir sistemi ve talamusa aktarılmaktadır. Kortikal merkez tarafından duyusal bilgiler ile birlikte ağrı deneyimlenir. Glutamat ve P maddesi nörokimyasal olarak en sık ağrının iletiminde yer alır. Nöropatik ağrının patofizyolojisi yeterince anlaşılamadığı için tedavi edilmesi zorlu olabilmektedir. Klinisyenin, nöropatik ağrıyı teşhis etmesi, uygun tedavi yönetimi ile ilişkilidir. Nöropatik ağrı sendromları da bu açıdan önem taşımaktadır. Alınan öykü, yapılan fizik muayene ve ek olarak yapılmış testler tanıya yardımcıdır. Tedavide trisiklin antidepresanlar, serotonin ve norepinefrin geri alım inhibitörleri, gabapentinoid grubu ilaçlardan destek alınmaktadır
Sonuç olarak nöropatik ağrı multidisipliner ve multimodal yaklaşım gerektiren bir durumdur.
Referanslar
Schlereth, T. Guideline “diagnosis and non interventional therapy of neuropathic pain” of the German Society of Neurology (deutsche Gesellschaft für Neurologie). Neurol. Res. Pract. 2020, 2, 16.
Scholz, J.; Finnerup, N.B.; Attal, N.; Aziz, Q.; Baron, R.; Bennett, M.I.; Benoliel, R.; Cohen, M.; Cruccu, G.; Davis, K.D.; et al. The IASP classification of chronic pain for ICD-11: Chronic neuropathic pain. Pain 2019, 160, 53–59.
Uyar M, Köken İ. Kronik ağrı nörofizyolojisi. TOTBİD Dergisi 2017; 16:70–76 doi: 10.14292/totbid.dergisi.2017.12
Colloca, L.; Ludman, T.; Bouhassira, D.; Baron, R.; Dickenson, A.H.; Yarnitsky, D.; Freeman, R.; Truini, A.; Attal, N.; Finnerup, N.B.; et al. Neuropathic pain. Nat. Rev. Dis. Primers 2017, 3, 17002.
Mylius, V.; Lloret, S.P.; Cury, R.G.; Teixeira, M.J.; Barbosa, V.R.; Barbosa, E.R.; Moreira, L.I.; Listik, C.; Fernandes, A.M.; de Lacerda Veiga, D. The Parkinson disease pain classification system: Results from an international mechanism-based classification approach. Pain 2021, 162, 1201.
Yeo, J.; Sia, A.T.; Sultana, R.; Sng, B.L.; Tan, E.C. Analysis of SCN9A Gene Variants for Acute and Chronic Postoperative Pain and Morphine Consumption After Total Hysterectomy. Pain Med. 2020, 21, 2642–2649.
Xiong, W.; Ping, X.; Ripsch, M.S.; Chavez, G.S.C.; Hannon, H.E.; Jiang, K.; Bao, C.; Jadhav, V.; Chen, L.; Chai, Z.; et al. Enhancing excitatory activity of somatosensory cortex alleviates neuropathic pain through regulating homeostatic plasticity. Sci. Rep. 2017, 7, 12743.
Liao, M.-F.; Yeh, S.-R.; Lu, K.-T.; Hsu, J.-L.; Chao, P.-K.; Hsu, H.-C.; Peng, C.-H.; Lee, Y.-L.; Hung, Y.-H.; Ro, L.-S. Interactions between Autophagy, Proinflammatory Cytokines, and Apoptosis in Neuropathic Pain: Granulocyte Colony Stimulating Factor as a Multipotent Therapy in Rats with Chronic Constriction Injury. Biomedicines 2021, 9, 542.
Gilron I, Baron R, Jensen T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clin Proc. 2015 Apr;90(4):532-45. doi: 10.1016/j.mayocp.2015.01.018.
10.Baron, R.; Binder, A.; Wasner, G. Neuropathic pain: Diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010, 9, 807–819.
Woolf CJ; American College of Physicians; American Physiological Society. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004;140(6):441–51.
Baron, R. Mechanisms of disease: Neuropathic pain--a clinical perspective. Nat. Clin. Pract. Neurol. 2006, 2, 95–106.
Svajdova, S.; Buday, T.; Brozmanova, M. Lidocaine, a Non-selective Inhibitor of Voltage-Gated Sodium Channels, Blocks Chemically-Induced Cough in Awake Naïve Guinea Pigs. Adv. Exp. Med. Biol. 2019, 1160, 1–9.
McDermott, L.A.; Weir, G.A.; Themistocleous, A.C.; Segerdahl, A.R.; Blesneac, I.; Baskozos, G.; Clark, A.J.; Millar, V.; Peck, L.J.; Ebner, D.; et al. Defining the Functional Role of Na(V)1.7 in Human Nociception. Neuron 2019, 101, 905–919.e908.
MacDonald, D.I.; Sikandar, S.; Weiss, J.; Pyrski, M.; Luiz, A.P.; Millet, Q.; Emery, E.C.; Mancini, F.; Iannetti, G.D.; Alles, S.R.A.; et al. A central mechanism of analgesia in mice and humans lacking the sodium channel Na(V)1.7. Neuron 2021, 109, 1497–1512.e1496.
Liu, X.D.; Yang, J.J.; Fang, D.; Cai, J.; Wan, Y.; Xing, G.G. Functional upregulation of nav1.8 sodium channels on the membrane of dorsal root Ganglia neurons contributes to the development of cancer-induced bone pain. PLoS ONE 2014, 9, e114623.
Hockley, J.R.; Boundouki, G.; Cibert-Goton, V.; McGuire, C.; Yip, P.K.; Chan, C.; Tranter, M.; Wood, J.N.; Nassar, M.A.; Blackshaw, L.A.; et al. Multiple roles for NaV1.9 in the activation of visceral afferents by noxious inflammatory, mechanical, and human disease-derived stimuli. Pain 2014, 155, 1962–1975.
Baron, R. Mechanisms of disease: Neuropathic pain--a clinical perspective. Nat. Clin. Pract. Neurol. 2006, 2, 95–106.
Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P,Hughes R, Nurmikko T, Serra J. Neuropathic pain: redefinition and a grading systemfor clinical and research purposes. Neurology70:1630–1635,2008.
Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DL, Bouhassira D,Cruccu G, Freeman R, Hansson P, Nurmikko T, Raja SN, Rice AS, Serra J, Smith BH,Treede RD, Jensen TS. Neuropathic pain: an updated grading system for research andclinical practice. Pain 157: 1599–1606, 2016.
Finnerup NB, Kuner R, Jensen TS. Neuropathic Pain: From Mechanisms to Treatment. Physiol Rev. 2021 Jan 1;101(1):259-301.
BennettM.TheLANSSPainScale:theLeedsassessmentofneuropathic symptoms and signs. PAIN 2001;92:147–57
Alkan H, Ardic F, Erdogan C, Sahin F, Sarsan A, Findikoglu G. Turkish Version of the painDETECT Questionnaire in the Assessment of Neuropathic Pain: A Validity and Reliability Study. Pain Med. 2013 Aug 7. doi: 10.1111/pme.12222.
Bouhassira D, Attal N, Alchaar H, Boureau F, Bruxelle J, Cunin G, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29-36.
Huang, C.; Zou, W.; Lee, K.; Wang, E.; Zhu, X.; Guo, Q. Different symptoms of neuropathic pain can be induced by different degrees of compressive force on the C7 dorsal root of rats. Spine J. 2012, 12, 1154–1160.
Bidve, P.; Prajapati, N.; Kalia, K.; Tekade, R.; Tiwari, V. Emerging role of nanomedicine in the treatment of neuropathic pain. J. Drug Target. 2020, 28, 11–22.
Shinu P, Morsy MA, Nair AB, Al Mouslem AK, Venugopala KN, Goyal M, Bansal M, Jacob S, Deb PK. Novel Therapies for the Treatment of Neuropathic Pain: Potential and Pitfalls. J. Clin. Med. 2022, 11, 3002. https://doi.org/10.3390/jcm11113002.
Doshi, T.L.; Dworkin, R.H.; Polomano, R.C.; Carr, D.B.; Edwards, R.R.; Finnerup, N.B.; Freeman, R.L.; Paice, J.A.; Weisman, S.J.;
Raja, S.N. AAAPT Diagnostic Criteria for Acute Neuropathic Pain. Pain Med. 2021, 22, 616–636.
Bennett MI, M.M. Backonja NA, Baron R, Bouhassira D, Freynhagen R,, Scholz J, Tölle TR, Wittchen H-U, Jensen TS. Using screening tools to identify neuropathic pain Pain, 2007; 127(3):199-203.
Truini A, Aleksovska K, Anderson CC, et al. Joint European Academy of Neurology-European Pain Federation Neuropathic Pain Special Interest Group of the International Association for the Study of Pain guidelines on neuropathic pain assessment. Eur J Neurol. 2023; 30 (8):2177-2196.
Cruccu G, Sommer C, Anand P, et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol. 2010;17(8):1010–8.
De Stefano G, Truini A. An overview of diagnosis and assessment methods for neuropathic pain. Presse Med 53 (2024) 104234.
Ünlütürk Z. Nöroloji Kliniği ve Nöropatik Ağrı: Kocaeli İli Üçüncü Basamak Hastane Tek Merkez Verileri. Kocaeli Med J 2023; 12 (2): 230-232.
Ertem U. Nöropatik Ağrı Tedavisi. Kocaeli Med J 2024;13(1):4-5, doi: 10.5505/ktd.2024.3206.
Yeung AM, Huang J, Nguyen KT, Xu NY, Hughes LT, Agrawal BK, Ejskjaer N, Klonoff DC. Painful Diabetic Neuropathy: The Need for New Approaches. J Diabetes Sci Technol. 2024;18(1):159-167.
Gündoğdu DK, Köktekir E, Doğan Ş. Servikal Disk Hernisi Nedenli Radikülopatilerde Medikal Tedavi. Türk Nöroşir Derg.2022; 32(3):328-330.
Fisher R, Clarkson E. Medication Management of Neuropathic Pain Disorders. Dent Clin N Am. 2024; (68): 121–131.
Mareboina M, Bastian D, Juengst SB, Annaswamy T. Insights into optimizing phantom pain management: A human-centered approach to end-user perspectives. PM&R. 2024;1–8.
