nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2013-2419nnp-198Research ArticleArticlesСтатьиPharmacoresistant neuropathic pain: Role of proper assessment in the understanding and tactics of correctionФармакорезистентная нейропатическая больChuryukanovMaksim ValeryevichChuryukanovMaksim Valeryevichmchurukanov@gmail.comDorokhovE VDorokhovE V-20130611201352NO2 (2013)8488Copyright © Churyukanov M.V., Dorokhov E.V., 20132013Churyukanov M.V., Dorokhov E.V.Churyukanov M.V., Dorokhov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/198

The paper gives information on the state-of-the-art of pharmacoresistant neuropathic pain (PNP). It presents the definitions of PNP, which make it possible to accurately identify such patients and to plan tactics for their treatment. Similarities and differences in scales and questionnaires for the valid identification of a neuropathic pain component are discussed. General information is given on international guidelines for the treatment of neuropathic pain, the use of stepwise therapy, and indications for neurostimulation.

Представлены сведения о состоянии проблемы фармакорезистентной нейропатической боли (ФНБ). Приводятся определения ФНБ, позволяющие точно выделить таких пациентов и спланировать тактику их лечения. Обсуждаются общее и различное в шкалах и опросниках для обоснованной идентификации нейропатического компонента боли. Даны основные сведения о международных рекомендациях по лечению нейропатической боли, использованию ступенчатой терапии, показаниях к проведению нейростимуляции.

фармакорезистентная нейропатическая больоценка болимеждународные рекомендации по лечению нейропатической болинейростимуляцияpharmacoresistant neuropathic painpain assessmentinternational guidelines for the treatment of neuropathic painneurostimulationReferences<div><p>Treede R.D., Jensen T.S., Campbell J.N., et al. Neuropathic pain: redefinition and a grading system for clinical research purposes. Neurology 2008;70:1630—5.</p><p>Gore M., Brandenburg N.A., Hoffman D.L. et al. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J Pain 2006;7:892—900.</p><p>Jensen M.P., Chodroff M.J., Dworkin R.H. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology 2007;68:1178—82.</p><p>McDermott A.M., Toelle T.R., Rowbotham D.J. et al. The burden of neuropathic pain: results of a cross-sectional survey. Eur J Pain 2006;10:127—35.</p><p>O’Connor A.B. Neuropathic pain: a review of the quality of life impact, costs, and cost-effectiveness of therapy. Pharmacoeconomics 2009;27:95—112.</p><p>Oster G., Harding G., Dukes E. et al. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain 2005;6:356—63.</p><p>Jensen T.S., Baron R., Haanpaa M. et al. A newdefinition of neuropathic pain. PAIN 2011;152:2204—5.</p><p>Bouhassira D., Lanteri-Minet M., Attal N. et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;136:380—7.</p><p>Torrance N., Smith B.H., Bennett M.I., Lee A.J. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 2006;7:281—9.</p><p>Данилов А.Б., Давыдов О.С. Эпидемиология нейропатической боли. Боль 2007;4(17):12—6.</p><p>Яхно Н.Н., Кукушкин М.Л., Давыдов О.С. и др. Результаты Российского эпидемиологического исследования распространенности невропатической боли, ее причин и характеристик в популяции больных, обратившихся к врачу-неврологу. Боль 2008;3:24—32.</p><p>Niv D., Devor M. Refractory neuropathic pain: the nature and extent of the problem. Pain Pract 2006;6:3—9.</p><p>Stacey B.R., Dworkin R.H., Murphy K. et al. Pregabalin in the treatment of refractory neuropathic pain: results of a 15-month open-label trial. Pain Med 2008;9:1202—8.</p><p>Taylor R.S. Epidemiology of refractory neuropathic pain. Pain Pract 2006;6:22—6.</p><p>Scottish Medicines Consortium. Scottish Medicines Consortium advice to NHS Scotland. Briefing note. Pregabalin (Lyrica). NHS Scotland 2009. Report No. 18. http://www.scottishmedicines.org.uk/files/briefi ng-notes/2009/ Briefing_note_smc_May09.pdf.</p><p>Hansson P.T., Attal N., Baron R., Cruccu G. Toward a definition of pharma-coresistant neuropathic pain. Eur J Pain 2009;13:439—40.</p><p>Freynhagen R., Baron R. The evaluation of neuropathic components in low back pain. Cur Pain Head Rep 2009;13:185—90.</p><p>Smart K.M., O’Connell N.E., Doody C. Towards a mechanisms-based classification of pain in musculoskeletal physiotherapy? Phys Ther Rev 2008;13:1—10.</p><p>Walsh J., Rabey M., Hall T.M. et al. Agreement and correlation between the selfreport leeds assessment of neuropathic symp toms and signs and douleur neuropathique 4 questions neuropathic pain screening tools in subjects with low backFrelated leg pain. J Manipul Physiol Ther 2012;35(3):196-202.</p><p>Freynhagen R., Baron R., Gockel U., Tö lle T.R. Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Cur Med Res Opin 2006;22:1911-20.</p><p>Scholz J., Mannion R.J., Hord D.E. et al. A novel tool for the assessment of pain: validation in low back pain. PLoS Med 2009;6(4): e1000047. doi:10.1371/journal.pmed.1000047.</p><p>Smart K.M., Blake C.C., Doody C.C. et al. Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (+leg) pain. Man Ther 2012;17:345-51.</p><p>Smith B.H., Torrance N., Ferguson J.A. et al. Towards a definition of refractory neuropathic pain for epidemiological research. An international Delphi survey of experts. BMC Neurol 2012;12:29.</p><p>Torrance N., Ferguson A.J., Afolabi E. et al. Neuropathic pain in the community: More under-treated than refractory? Pain 2013;154:690-9.</p><p>Dworkin R.H., O’Connor A.B., Backonja M. et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132:237-51.</p><p>Moulin D.E., Clark A.J., Gilron I. et al. for the Canadian Pain Society. Pharmacological management of chronic neuropathic pain — consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag 2007;12:13-21.</p><p>Attal N., Cruccu G., Haanp К.К.M. et al. for the EFNS Task Force. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006;13:1153-69.</p><p>Oxford Centre for Evidence-based Medicine. Levels of evidence and grades of recommendation. Available at: http://www.cebm.net/index.aspx?o=1025. Accessed March 24, 2009.</p><p>Cruccu G., Aziz T.Z., Garcia-Larrea L. et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol 2007;14:952-70.</p></div><br /><div><p>Treede R.D., Jensen T.S., Campbell J.N., et al. Neuropathic pain: redefinition and a grading system for clinical research purposes. Neurology 2008;70:1630—5.</p><p>Gore M., Brandenburg N.A., Hoffman D.L. et al. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J Pain 2006;7:892—900.</p><p>Jensen M.P., Chodroff M.J., Dworkin R.H. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology 2007;68:1178—82.</p><p>McDermott A.M., Toelle T.R., Rowbotham D.J. et al. The burden of neuropathic pain: results of a cross-sectional survey. Eur J Pain 2006;10:127—35.</p><p>O’Connor A.B. Neuropathic pain: a review of the quality of life impact, costs, and cost-effectiveness of therapy. Pharmacoeconomics 2009;27:95—112.</p><p>Oster G., Harding G., Dukes E. et al. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain 2005;6:356—63.</p><p>Jensen T.S., Baron R., Haanpaa M. et al. A newdefinition of neuropathic pain. PAIN 2011;152:2204—5.</p><p>Bouhassira D., Lanteri-Minet M., Attal N. et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008;136:380—7.</p><p>Torrance N., Smith B.H., Bennett M.I., Lee A.J. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 2006;7:281—9.</p><p>Данилов А.Б., Давыдов О.С. Эпидемиология нейропатической боли. Боль 2007;4(17):12—6.</p><p>Яхно Н.Н., Кукушкин М.Л., Давыдов О.С. и др. Результаты Российского эпидемиологического исследования распространенности невропатической боли, ее причин и характеристик в популяции больных, обратившихся к врачу-неврологу. Боль 2008;3:24—32.</p><p>Niv D., Devor M. Refractory neuropathic pain: the nature and extent of the problem. Pain Pract 2006;6:3—9.</p><p>Stacey B.R., Dworkin R.H., Murphy K. et al. Pregabalin in the treatment of refractory neuropathic pain: results of a 15-month open-label trial. Pain Med 2008;9:1202—8.</p><p>Taylor R.S. Epidemiology of refractory neuropathic pain. Pain Pract 2006;6:22—6.</p><p>Scottish Medicines Consortium. Scottish Medicines Consortium advice to NHS Scotland. Briefing note. Pregabalin (Lyrica). NHS Scotland 2009. Report No. 18. http://www.scottishmedicines.org.uk/files/briefi ng-notes/2009/ Briefing_note_smc_May09.pdf.</p><p>Hansson P.T., Attal N., Baron R., Cruccu G. Toward a definition of pharma-coresistant neuropathic pain. Eur J Pain 2009;13:439—40.</p><p>Freynhagen R., Baron R. The evaluation of neuropathic components in low back pain. Cur Pain Head Rep 2009;13:185—90.</p><p>Smart K.M., O’Connell N.E., Doody C. Towards a mechanisms-based classification of pain in musculoskeletal physiotherapy? Phys Ther Rev 2008;13:1—10.</p><p>Walsh J., Rabey M., Hall T.M. et al. Agreement and correlation between the selfreport leeds assessment of neuropathic symp toms and signs and douleur neuropathique 4 questions neuropathic pain screening tools in subjects with low backFrelated leg pain. J Manipul Physiol Ther 2012;35(3):196-202.</p><p>Freynhagen R., Baron R., Gockel U., Tö lle T.R. Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Cur Med Res Opin 2006;22:1911-20.</p><p>Scholz J., Mannion R.J., Hord D.E. et al. A novel tool for the assessment of pain: validation in low back pain. PLoS Med 2009;6(4): e1000047. doi:10.1371/journal.pmed.1000047.</p><p>Smart K.M., Blake C.C., Doody C.C. et al. Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (+leg) pain. Man Ther 2012;17:345-51.</p><p>Smith B.H., Torrance N., Ferguson J.A. et al. Towards a definition of refractory neuropathic pain for epidemiological research. An international Delphi survey of experts. BMC Neurol 2012;12:29.</p><p>Torrance N., Ferguson A.J., Afolabi E. et al. Neuropathic pain in the community: More under-treated than refractory? Pain 2013;154:690-9.</p><p>Dworkin R.H., O’Connor A.B., Backonja M. et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132:237-51.</p><p>Moulin D.E., Clark A.J., Gilron I. et al. for the Canadian Pain Society. Pharmacological management of chronic neuropathic pain — consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag 2007;12:13-21.</p><p>Attal N., Cruccu G., Haanp К.К.M. et al. for the EFNS Task Force. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006;13:1153-69.</p><p>Oxford Centre for Evidence-based Medicine. Levels of evidence and grades of recommendation. Available at: http://www.cebm.net/index.aspx?o=1025. Accessed March 24, 2009.</p><p>Cruccu G., Aziz T.Z., Garcia-Larrea L. et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol 2007;14:952-70.</p></div><br />

The authors declare that there are no conflicts of interest present.