【正文】
ponds to local anaethetics 對局部麻醉劑有反應(yīng) nerve entrapment 神經(jīng)的壓迫(yāp242。)性損害,True neuropathic pain 真性神經(jīng)病性疼痛 damage irreversible 不可逆損傷 central sensitization (spinal cord, brain) 中樞神經(jīng)(zhōngshūsh233。njīng)敏化(脊索,腦) classical analgesics and anesthetics frequently ineffective普通鎮(zhèn)痛劑和麻醉劑常常無效 adjuvant analgesics like TCA are effective 輔助鎮(zhèn)痛劑有效,如TCA類 nerve section 神經(jīng)切除,第八頁,共三十二頁。,第九頁,共三十二頁。,第十頁,共三十二頁。,第十一頁,共三十二頁。,背角的初級傳入纖維的正常終端(zhōnɡ duān) 神經(jīng)損傷以后,C纖維終端萎縮而A纖維終端長入后角表層,第十二頁,共三十二頁。,第十三頁,共三十二頁。,“輔助性鎮(zhèn)痛劑…” 所有的藥物,包括尚未被許可用于治療疼痛(t233。ngt242。ng),但對于改善鎮(zhèn)痛質(zhì)量有用的藥物。這些藥物可能有經(jīng)典鎮(zhèn)痛劑的內(nèi)在鎮(zhèn)痛活性或潛在活性,或減低經(jīng)典鎮(zhèn)痛劑的毒性作用。 “Adjuvant analgesics…” All drugs, not licensed as such for the treatment of pain, but useful to improve the quality of analgesia. They may have an intrinsic analgesic activity or may potentiate the activity of classical analgesics or diminish their toxic effects.,第十四頁,共三十二頁。,我們(wǒ men)將討論哪些藥物? About which drugs we are talking about?,Antidepressants 抗抑郁劑 Anxiolytics 抗焦慮劑 Anticonvulsants 抗驚厥藥物 NMDA inhibitors N甲基D天冬氨酸抑制(y236。zh236。) 劑類 Muscle relaxants 肌肉松弛劑 Psychostimulants 精神興奮劑 Neuroleptics 精神抑制劑 Corticosteroids 糖皮質(zhì)激素,第十五頁,共三十二頁。,抗抑郁劑 Antidepressants,amitriptylline (Tryptizol174。) 阿米替林 imipramine (Tofranil174。) 丙咪嗪 Venlafaxine (Efexor174。) 文拉法辛 Paroxetine (Seroxat174。) 帕羅西汀 Mirtazapine