(Clinical Practice Guideline for Neuropathic Pain)

.. 2551

(Clinical Practice Guideline for Neuropathic Pain)

.. 2551
ISBN: 978-974-598-056-3




(Clinical Practice Guideline for Neuropathic Pain)

..
2551
(Clinical PracticeISBN:
Guideline for Neuropathic Pain)
978-974-598-056-3
..2551


ISBN: 978-974-598-056-3

ISBN: 978-974-598-056-3

1
2551

4,000

,
 }no
o
o{non

on nno

oonoo
nrn
o }
 Neuropathic pain

(general practitioners)

. .

1. ..r
n
2. ..r
n
3. ... r
n
4. ..r r n
5. .. rrdrn
6. .. r rrg n
7. .r rn
8. ..r o rn
9. .. rn n
10. .. r rrn
11. . rr
12. . rn
13. ..o r i
n
14. .r nr r
on
15. . r
on





CPG

1 1
1.1 1
1.2 2
2 3
3 7
3.1 7
3.2 12
3.3 15
4 20
4.1 Diabetic peripheral neuropathy 20
4.2 Post herpetic neuralgia 22
4.3 Trigeminal neuralgia 23
4.4 Phantom limb pain 24
4.5 Central pain 25
4.6 26
5 27
1 (Quality of evidence) 28
2 29
3 32
4 33
5 35
6 Thai DN4 36
37

 o o CPG
CPG n j CPG
o o CPG o
do }
on

(Strength of Recommendation)
++ on
nrnnoion (cost effective)
+ on
nrnoion
n
+/- no
nnon
nrnoi non nnnon
oi n{
n
- on
nnrnoinon n} n
n
- - on
nnonoi n

(Classification of references)
Level of evidence A o systematic review randomized,
controlled clinical trials o randomized, controlled
clinical trials n
Level of evidence B o systematic review controlled clinical
study o controlled clinical study (n
nonrandomized, controlled trial, cohort study, case-control study,
cross sectional study) n o
o r


 n nn
randomized, controlled clinical trials no
o randomized, controlled clinical trials n
o o } o
systematic review randomized, controlled clinical trials
randomized, controlled clinical trials n
Level of evidence C o systematic review descriptive study
o descriptive study oi
n o systematic review
controlled clinical study controlled clinical study n
o controlled clinical trials n
o
Level of evidence D o (consensus)
o n
nnor

o

: Level of evidence (rn e 18 6

..- .. 2544)

 oo
or/ooo
oo Medline, Cochrane library, EMBASE o ne 1966
2008 on neuropathic pain, epidemiology, assessment,
treatment, diagnosis, guideline, rehabilitation, complementary medicine, alternative
medicine, acupuncture, central pain, post herpetic neuralgia, trigeminal neuralgia, diabetic
peripheral neuropathy
n key articles n

 1
1.1
Neuropathic pain }
somatosensory system nn o
(lancinating) o (burning) on (tingling)
o (pins and needles) (itching) (paresthesia) on
(stimulus- independent pain spontaneous pain) o
(stimulus- dependent pain stimulus-evoked pain) o on
on o n allodynia oi
oonoo o n
hyperalgesia
Neuropathic pain onoi}
onoi nn
oi
oon neuropathic pain }nn
n oi HIV o
n o n neuropathic pain nn
}nn neuropathic pain
oi (mixed pain) o}
nnoi neuropathic pain n
n neuropathic pain }n nn n n
}n diabetic neuropathy, multiple sclerosis nn
n o oonoon
n} neuropathic pain e .. 1994 International
Association for the Study of Pain o neuropathic pain o neuropathic pain
on on 1
nnn n nno}n
n}onoon somatosensory pathways
spino-thalamocortical system

1 
 n on } o
n neuropathic pain oo2
o o neuropathic pain n}
e.. 2007 2nd Congress of Neuropathic Pain r o
onn }n somatosensory system
(Pain arising as a direct consequences of disease affecting the somatosensory system)3
noonnon o
n (hyperexcitability)
(plasticity) nn neuropathic pain neuropathic pain o
4
o nn

1.2
neuropathic pain nn
nn n multiple sclerosis
o n post herpetic neuralgia n
n spinal cord injury nn post mastectomy syndrome phantom pain
amputation nnn low back
pain sciatica }o
neuropathic pain n
n oi
oo 6.8-8.25, 6 }o 37.8-48
oi7, 8 oi}n
nnn oioo 369 nn
n n n post
herpetic neuralgia oo 10-1510 oioo 16-2611 low back
pain oo 54.712 }o nn post
stroke pain oo 813 multiple sclerosis oo 27.514
oo 13- 38 15, 16, 17 n neuropathic pain n n post mastectomy
syndrome oo 2018
Neuropathic pain }noi19
noon n o 20 non
noin neuropathic pain21, 22

2

2
} } n
o n
}} oooo o
o
noi ro}
n } nociceptive, neuropathic, psychogenic
} neuropathic pain nn
oo r}o n
n} (pathognomonic sign)
neuropathic pain ooon
(neuroanatomy) o i
oon no
neuropathic pain n o
( 2.1 2.1)


 2.1 ( 4, 5 6)

n ( 4)
oo DN4 ( Thai +
DN4 6)
on
1. o ++
2. n o o o ++
n
3. o ++
o
4. no nn}, o ++
, oo,
5. o oo n +
6. o +

o 1 2 n
+ o 3-6 1 o n

Neuropathic pain nn
neuropathic pain
o

()
x o visual analog scale numerical rating scale ++
x o +/-
x oo +
n

4
 NEUROPATHIC PAIN
Definite
x Document of nerve
Probable lesion
x Decreased sensibility in x Decreased sensibility
Possible painful area in painful area
x History of relevant x History of relevant x History of relevant
disease or lesion in disease or lesion in the disease or lesion in
the nervous system nervous system the nervous system
x Pain in neuro- x Pain in neuro- x Pain in neuro-
anatomical area anatomical area anatomical area

2.1 neuropathic pain1

}ooir neuropathic pain

o}n
nn } n oo
oinoo { neuropathic pain noo
r ( 2.1) on Neuropathic Pain Scale (NPS)2, Neuropathic Pain
Questionnaire (NPQ)3, NPQ short form4, Neuropathic Pain Symptom Inventory (NPSI)5, ID
Pain6, DN47, PainDetect8 LANSS Pain Scale9 ( 5) non
ron oio no
o rno n nooinn
oono or
no }noo DN410 ( Thai DN4
6)
o (quantitative) nrn
neuropathic pain n o (qualitative) nn} o
o o o
on o oo
o on spontaneous ongoing pain, spontaneous paroxysmal pain,
dysesthesia paresthesia o (evoked pains) } allodynia
hyperalgesia on
1. Visual analogue scale (VAS) }o n
nn11 VAS }o 10 no


5
 ono o
( 2.2 A)
2. Numerical rating scale (NRS) nno 11-point Likert scale (0 = no pain, 10 =
worst possible pain) ( 2.2 B)
3. Verbal rating scales (VRS) o n ooi (
2.2 C)
4. Wong-Baker faces pain rating scale
n 3 eno n numerical rating scale o
oo o
o ( 2.2 D)
A

n o

B
n o
0 1-3 4-6 7-10

C
0 1 2 3 4 5 6 7 8 9 10
n o
D

2.2 A: Visual analogue scale (VAS), B: Numerical rating scale

(NRS), C: Verbal rating scales (VRS), D: Wong-Baker faces pain rating scale


 n o
o n on
n ( 2.3)

2.3 nno

oo
Quantitative Sensory Testing (QST) nooo oo
nn o oo
no oo o
}o
n oo
allodynia hyperalgesia



 oi*

n
on
?A
oi}

nn

} first-line drug

first-line drug
n 1
o?B
n
( 1)
nn

n
o?C oo first-line
nono
oo second-line
( 3.1)

nnoio
o first-line drug

* nono
A Average pain score VAS NRS < 3/10 oioo

B Average pain score VAS NRS > 4/10 oooo 4-8 r

C Average pain score VAS NRS on 30% ooon

4-8 ro


 3.1 onn o neuropathic pain
o o

1. First-line medications oi oin

1.1 Tricyclic antidepressants
- Amitriptyline Enhance 10-75 ./ n, o ++ --
descending o, o oi no
inhibitory anticholinergic, oi oi
pain pathway 10-25 . o oi oi
n o
o n
anticholinergic* od
10-
- Nortriptyline 25 . + -
1-2 r (
n 75
./)
- Imipramine - --
1.2 Calcium channel D2G1 ligands
- Gabapentin Block D2G1 300-3600 n, o + ++
subunit of ./ rn oi oo
calcium o 100- o oi
channel 300 . n n
oi
n
100- o
300 . d
3-7
no
2-4
1.3 Sodium channel blockers
- Carbamazepine Block sodium 200-1200 o o + -
channel ./ no
o o oi
o
- Oxcarbazepine 300-1800 { + -
./ no
oi

n
*o anticholinergic n o o n o { n o

10
10
 3.1 onno neuropathic pain (n)
o o

2. Second-line medications oi oin
2.1 Tramadol -Weak P 50-400 ./ o - + +/-
agonist o oo i o
n o o oi
-Enhance on n SSRIs oio
descending SNRIs SSRIs
inhibitory pain - SNRIs
pathway oi TCAs
n
2.2 Oral morphine P agonist o - o + +/-
o oi n o
oi n - oi
oi n
n tramadol r

2.3 Methadone P agonist o - n + +/-

NMDA o n n o
antagonist oi n oi
on n
tramadol
on o
oi morphine
no
2.4 Pethidine P agonist no neuropathic pain o --
on
2.4 Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Venlafaxine Enhance 75-150 ./ o o + +/-
descending oi o
Inhibitory pain o non oi
pathway tramadol
n no

- Duloxetine* 30-60 ./ serotonin + +/-
syndrome o
oi

no

2.5 Calcium channel D2G1 ligands

- Pregabalin Block D2 G1 75-600 ./ n, o + ++
subunit of ,rn oi oo
calcium o oi
channel n oi
n
o
d
2.6 Paracetamol, NSAIDs, no chronic neuropathic pain n --
COX-2 inhibitors o
*nn : Duloxetine n 31 2549

11
11
 3.2 o neuropathic pain
neuropathic pain
Burning Lancinating Hyperalgesia Allodynia Paresthesia,
dysesthesia
TCA Amitriptyline ++ +/- ++ ++ +
SNRI Venlafaxine + +/- + + +/-
Duloxetine ++ +/- ++ + +/-
Sodium channel Carbamazepine +/- ++ + + +
blockers Oxcarbazepine +/- ++ + + +
Calcium channel Gabapentin ++ +/- ++ ++ +
D2G1 ligands Pregabalin ++ +/- ++ ++ +
Opioids Tramadol + +/- + + +
Morphine +/- +/- +/- +/- +/-

3.3 o} neuropathic pain

} neuropathic pain
DPN PHN TGN Phantom Central pain
limb pain
TCA Amitriptyline ++ ++ +/- + ++
SNRI Venlafaxine + + - - +/-
Duloxetine ++ + - - +/-
Sodium channel Carbamazepine +/- +/- ++ + +
blockers Oxcarbazepine +/- +/- ++ + +
Calcium channel Gabapentin ++ ++ +/- + +
D2G1 ligands Pregabalin ++ ++ +/- + +
Opioids Tramadol + + - +/- +/-
Morphine +/- +/- - +/- +/-
DPN: diabetic peripheral neuropathy, PHN: post herpetic neuralgia, TGN: trigeminal neuralgia

12
3.2 n
3.4 o neuropathic pain n
on n n

Trigeminal neuralgia 1. nn Microvascular decompression ++ x 68-95%
o (MVD) x 70 95% n
2. n n
oo x 72 73% n
3. vascular loop 5-6 e
compression
x 0.1%
x 1 % o

1. nn Gamma knife +/- x 47 88 % n 1

o e (75 92.9 % 1 e)
2. n x 24 74 % n
oo 18 3 e ( 48
90% )
x 10% nno
SRS
x oon
persistent paresthesia (
15.8% o non
n 16.3% o
nn
Radiofrequency + x 83 97% n
thermoregulation n
x 49 70% n
5-7 e
x }
Motor cortex stimulation +/- x 10% o,
42% o, 35%
on, 13%
nn
x 36% oo
Post herpetic neuralgia 1. nn Dorsal root entry zone +/- x n DREZ spinal
o (DREZ) dressing cord stimulation (60-70% for
2. n Spinal cord stimulation +/- DREZ) n
oo Motor cortex stimulation +/-
x non

13
 3.4 o neuropathic pain n (n)
on n n

Phantom limb pain 1. nn Dorsal root entry zone +/- x o traumatic
o (DREZ) lesion For general amputations associated with root
2. n avulsion
oo -- x on phantom
Stump pain stump pain stump pain
n
Deep brain stimulation (DBS) +/- x
DBS PVG/PAG grey matter
(79%) PVG/PAG plus
sensory thalamus/internal
capsule (87%)
x o sensory thalamus
noon (58%
long-term success) (p < 0.05)
x DBS o nociceptive
pain n deafferentation pain
(63% vs 47% long-term success;
p < 0.01)
3. oir x n neuroma +
nn n}n
o }

}n x noo +/-
r
n o



Thalamic pain 1. nn Deep brain stimulation +/- x Trial stimulation
o 50%
2. n oi post-stroke pain
oo 58% oi{
o
Motor cortex stimulation +/- x 10% o
, 42% o
, 35% on
, 13% nn
x 36% oo
Causalgia, Sympathetic 1. nn Sympathectomy + x oi
mediated pain o
2. n nnn
oo sympathetic n 66-96%
block o x oi 94% sympathectomy
o

14
3.3 rg r
r
Neuropathic pain }
nn nn oi ooir
o o
n
o noo o
ooi n oi
neuropathic pain j 2 1 on
1.
2. oi
jooin }j}o
o ooino
oi ooi
o n n o o n g
oi r r }o n
oin
ooi rnoon
rnoi o ooi}
oon o n
neuropathic pain no goi
nnnnr nn
o n nn RCT oio
}o nn}
o } (adjunctive therapy) n
oon
oon oo n
ono rrg
o g n j
o ooi
o n o n on
}o oo n o

15
15
 ooi2,3 on o
{o

3.3.1 r
g
neuropathic pain no 40 o
rg 5 alternative medicine 36 o
{ (acupuncture) } 3.5

3.5 rg
on o/oo o
Patient education ++

{o


TENS (Transcutaneous Chronic neuropathic - - 9 4,5,6,7 +
Electrical Nerve pain cardiac 200 (oi o
Stimulation) pacemaker -o r n
o)
- Hi-TENS (conventional) -oi on
on Hi frequency, low +/-
intensity allodynia n n oi
-Hi-TENS o o
- Lo-TENS (acupuncture- o o n, n
like) on Lo frequency, TENS o8 on Lo-TENS --
Hi intensity - no Hi-TENS
n oio cardiac
pacemaker
- oo

o
30
/
o

-
o Hi-TENS
Lo-TENS
o
n n
o
no} trial
& error o

accommodation
effects of nerve
nerve fiber
n

16
16
 3.5 rg (n)
on o/oo o
Relaxation techniques Neuropathic pain: - - o 7,8,17 +
n Postherpetic neuralgia n
peripheral
neuropathy oi

General Exercise - 6,7 ++

improve general condition oro
o

n
n
n
o


(immobilization
syndrome) o
oi n


o
n
r
n
- on

Specific exercise +/-

Heat & Cold n hot Neuropathic pain - burn ooi -n 7 +/-

pack, warm bath, ice } sensory impaired o o} oi
o --
nooi
sensory deficit
oi DM
Desensitization on Neuropathic pain -oi -} 9 +/-
o allodynia oo oo
n n o --
o ooi allodynia
no
(n
oi)

17
 3.3.2 r r
orr (Complementary &
Alternative Medicine: CAM) peripheral neuropathy no 43 o CAM
on (mega-vitamins o 35) n (magnet o 30) { (o 30)
(o 22) chiropractor (o 21)10 noio
rrn
ooio nonno oio
r r o 27 n o
onnnr}
on } o}
o nonn
o o CAM neuropathic pain
3.6

18
18
 3.6 r r
on o/oo o
{ Painful diabetic o -RCT 5,8,11 +/-
(Acupuncture) neuropathy, central -on (postherpetic neuralgia) o
neuropathic pain in -oon nn placebo, radiculopathy
spinal cord injury n oo sham, no trigeminal neuralgia
(SCI) o -ooi painful o
oi diabetic neuropathy, central o
neuropathic pain in SCI
{ - no o
n
oio nn +/-
-{ -} 1,6,12,13 Central NeP
-oi}n n o (SCI) painful
nn HIV, o diabetic neuropathy
hepatitis B oo
oo oo -
oof post-herpetic
neuralgia
-{ 1-3 n 10,14
r (10 /r) on
o 4-5

Painful peripheral -n 6,10 +

neuropathy neuropathic pain n Balanced diet
n}
neuropathic pain ++
- (balanced Avoid alcohol
diet)
- +/-
r MTV, B complex, 3B
(n 1 )
-o --
oi no B6
n 100 ./)
- no
o --
B6 Vitamin E > 400
o neuropathy o U/day o
Parkinson
disease
Alzheimers disease
Mild degree n -n peripheral +/-
(n neuropathic pain sensitization
n) -ono

19
19

4
4.1 Diabetic neuropathy

} o n n o o n o
o } n o n n o i
n oi}on
1 2 oo
2 o oinn} }
o nn oi nn }
oinn o nn
oi noo
1
o non
no 13.12 oin
n no 32.33 noinnno
i} n o 7-13 o4
}o 20-33% } 10 e4 ro
oi5

n no 3 n
1. Distal symmetric diabetic polyneuropathy (DSDP)
}non oinno
n n o o/ o 2 on
ooir o }
n o
nnoo
2. Autonomic neuropathy
(autonomic neuropathy) o
oi n DSDP ooin n o o
{ } n
20

20
 on }o noo
n QT oo
3. Focal and multifocal neuropathy
}no on
o ooon o
ro n n truncal radiculoneuropathy,
median, radial, ulnar peroneal nerve (entrapment)
oooo
ono
ooinn ,
noo on

(hyperglycemia) }no
ornr
r oo (reactive oxygen
species) o r n o n o
(advanced glycation endproducts AGEs)
polyol pathway protein kinase C }n
rn no
r6

oin no no
nnon 2
glucose tolerance test n n
o on serum electrophoresis, TSH, BUN, Creatinine
oin
{o (skin biopsy) oo

no}onn7 no
Quantitative sensory testing (QST) oo}
n

21
21

j : oon
j on non aldose
reductase inhibitors nerve growth factor nnr no
8,9
: no (focal or multifocal neuropathy)
oio no o
o n n (carbamazepine, gabapentin, pregabalin), n antidepressant
(amitryptyline, nortryptyline, duloxetine)10 oon opioid n
tramadol strong opioid ono }
} oo11 n topical capsaicin oo
0.075% neuropathic pain o12 oio
o fludrocortisone midodrine no
joo n
nn13

4.2 (Post herpetic neuralgia, PHN)

} varicella-zoster o
no r 2.2-3.4 n 1,000 ne
ro no
20 1 oioo
n n n
(dermatome) n n o
n r
oinon}o
nn} n 1-3
noi} (post herpetic neuralgia) on PHN
}o n oin
rn n}}
2
oo n acyclovir, valacyclovir famciclovir
o o 72
ono non
22
22
j PHN1,2 nor n
oono nnj PHN3
o amitryptyline oon
oo nn2
j PHN onj on
noj PHN noo4
onjo oo
onn}nn gabapentin pregabalin
oon TCAs tramadol orono on
no oono1,5

4.3 (Trigeminal neuralgia or Tic douloureux)

oo 5 noi
n r 5.9 3.4 n 100,000 ne
} j o
no}n o oo {
on 5 oo o
noin
n noinooo
o trigeminal ganglion
(sensory function) no
} 2 3 (V2,V3) n 1 (V1) oi o
(trigger point) {o n o { oi
}n nnn
oinn}1
nnnn oinn arterial venous
loop n 5 on
MRI brain nnn n
demyelination multiple sclerosis oio meningioma oi
nno ono carbamazepine
n}o 100 . 2-3
n } 600-1,200 .n} o
o oiojo n n

23

23
 noo o oxcarbazepine ono
n baclofen, phenytoin, gabapentin, lamotrigine }o1-3
oinoononnoinnn
no(2)
no o alcohol ooo
ganglion oi no
o nn micro vascular loop decompression (MVD)
nooo o Gamma
knife radiosurgery nn4
nnoon nonn
MVD }ooi 5

4.4 nr (Phantom limb pain)

nro ooi
nroo rnn1, 2 n
oioro nonron o
n phantom sensation n}
acute just post amputation pain noinnnn
n chronic residual limb pain
o o i r o n r o o
phantom phenomena oionr
oionnro
o non oionr
oo nn}{
n oio 60-80 onn
r (phantom pain) oinn}o
noio 5-10 o
ronnrnr
o (stump pain)
roon}onn
n}nn n
rononnor
n n j o
orn o (nerve block) o
24
24
 nroooi
ono
(randomized control trial) o
(neuropathic pain) n nro
oornnooi (non invasive
treatment) o}nooioro n n
onn ooioon
oonoo (antidepressants) n tricyclic
sodium channels calcium channels o opioids oin
oiorg ojo
onn o
ooo o
{o randomized controlled trials meta analysis
o nooio
oirroo roo
no

4.5 Central neuropathic pain

noo 8 oi
oo 40 oi
n n n n
nn spinothalamic pathway no
neuronal excitability
o n ooo
{o central neuropathic pain nnn
}oo n
n{oo randomized controlled
trial nn
1. Central neuropathic pain, post stroke : TCA
2. Spinal cord injury pain: calcium channel D2G1 ligands n pregabalin
3. Pain associated with multiple sclerosis: cannabinoids (level B)
4. Central neuropathic pain : pregabalin, TCAs, lamotrigine, gabapentin (level B)

25
25
 noin
nonoo onoonoo}
first second line o peripheral neuropathic pain o

4.6
nn (mixed pain) neuropathic pain }n
no
neuropathic pain oi no neuropathic pain
} nnoi neuropathic pain n
nn
x Cancer pain: neuropathic pain oi n
o oo
n o oinnon
opioids nnoon n gabapentin, pregabalin, TCAs,
SNRIs antiepileptics o
noio
x Painful polyneuropathy ooioo
n
o HIV neuropathy antiretrovirals
n CYP450 on CYP450 o n
gabapentin }o
o Drug-induced neuropathy }
o GuillainBarre syndrome o gabapentin carbama-
zepine on opioids ono
x Nerve injury pain n radicular pain (include back pain), post-traumatic/post-
surgical neuropathic pain complex regional pain syndromes (CRPS)
oi n o
paracetamol NSAIDs rn oi
oo neuropathic pain oo
neuropathic pain n non
oinn}
neuropathic pain

26
26
 rnn 5
neuropathic pain jon
j{ (chronic pain) noj
ro /o
noinn nn on
1. rn o neuropathic pain o
2. r oiooo
nn n 3 r oono 50
oi n 7/10
3. oioon first-line drugs no 2 on
n}ooon strong opioids
4. rnono invasive techniques /n
5. oin 1 e / n}
(chronic pain syndrome) nnn
5.1 n n

5.2 nooo
5.3 { o
n
5.4 oin
5.5 oon

5.6 oiroon
5.7 nn n

27

27
 1
(Quality of Evidence)

1 o
1.1 (systematic review) nnn-
(randomize-controlled clinical trials)
1.2 nnn- no 1 (a well-designed,
randomize-controlled, clinical trial)
2 o
2.1 nnonn (non-randomized, controlled,
clinical trials)
2.2 nnnn (well-designed, non-randomized, controlled
clinical trial)
2.3 (cohort) r
o (case control analytic studies) o}n
n nn/n
2.4 (multiple time series) n
on rr
n n o ..
2480 on
3 o
3.1 (descriptive studies)
3.2 o (fair-designed, controlled clinical trial)
4 o
4.1 o o (consensus)
o r
4.2 oinn onno 2

n o n r n o i
(anecdotal report) o non}

28
28
 2

(strength of recommendation) }j
o}roi}on (prolonged life)
i (decreased morbidity) o (improved quality of life)
ooio
o o o n n
onnonnn
jon (n oo
nooi io
/ooi) non o
no rn n
1 n}oo ++ ++ n}o
1 nn nnn
ron n (n no o
n 50 e o +/-) o
o Papanicolaou o ++ {
2
o n o
r oo
r} o
n n o n } } n
}on n
}n}no nj
oo onoonon on n
CT / MRI brain oi o ++
nn{ n
rnn} nor (
+/-) rn }oo +/- on:-
1. n{ooonr n
n n}
n
2. o
3. r ooo
4. nn

29
29
 5. n nr o
{o {rn n
12 oi
n on}rnrnoi
n non o
n n
n
nooo{o (systematic review and
consensus of peer reviewers) on n o
n n o o n o o o
o ooo
{ {/rnn
orn

r o 5
or
(1) j oo on

(2) joo o nn
nn
(3) j/ o (n )
}
o o 5 on
(1) (safety)
(2) r (efficacy)
(3) (effectiveness)
(4) rn (benefit of population and entire society)
(5) (efficiency)
n
1. (safety) on ji o
g o{
o o n n (safety
monitoring program: SMP) nr (n NNH: number needed to
harm) o on
n
2. r (efficacy) r}or o
no
no o{/o

30
30
ronr nr (n NNT: number
needed to treat) onr
3. (effectiveness) nooron
r no n n o
n/n oo/ono nono
on o
{/nrn
on
3.1 o }n
3.2 n o i
rnn on
3.3 nrnn }o
3.4 n rrnn }on
4. rn (benefit of population and entire society) o
ron }nrn
/n o r n
r (utility) {r o
r r n
nnn non
on}o nnoo
onn nooo
ooonnooi nno
5. (efficiency) ono 4 no
on ojonn
oojnooo
nn} n oo o}
o

31
31
 3
o

on:-
1. o ++, -- on /n
r nro
n on/non}n (oi)
oo 2 o n:-
1.1. 1 : nnn- (randomize-controlled, clinical trial)
no 1
1.2. 2 : nnnnn (non-randomized, controlled, clinical trial)
nnon no 2 on
1.2.1. n (cohort)
1.2.2. (case-control)
1.2.3. (multiple-time series) n o adrenaline o jo

2. o +, - on /n
r n n o n
rn on/non (oi) n
ooooo () n non/non /n
oro 1 on:-
2.1. o 1 ( 1 no 1 , 2 no 2 ) nnn

2.2. 3 / 4
3. o +/- on nnn r
n n o n
(rononnnr) n:-
3.1. n{ (ooo) nr
n
3.1.1. n
3.1.2. n}
3.1.3. r (surrogated end-point)
3.1.4. nn (safety monitoring program : SMP)
3.1.5. n.
3.2. ( 1 / 2) o
3.3. oo .
3.4.nr (ultimate end points) r
3.5.n nroo
{r n n

32
32
 4
n
n
Neuropathic pain ono 2
1. noo (stimulus-independent spontaneous pain)
o (burning) (intermittent shooting),
(lancinating sensations), (electric shock-like pain) oi
nn (tingling) non paresthesias non
nooi n} dysesthesias
2. o (stimulus-dependent stimulus-evoked pain)

Hyperalgesia }nno
oo on (mechanical) (thermal)
(chemical)
Allodynia o n oo
ooo rn
o
x Mechanical allodynia }n
oo oon (
1A)
x Thermal allodynia oo
oonnn 40 ( 1B)
no n neuropathic pain r
n o
o}
o ono oo
nooi}n o
r oo oi ( 2) n
1. oo oo
2. o o { oo (pinprick sense)
3. o r oo o
4. o (tuning fork) 128-Hz oo

33
33
 1 n neuropathic pain
A

2 roooi

34
 o neuropathic pain

NPS2 NPQ3 NPQ Short NPSI5 ID PAIN6 DN4 for Pain LANSS for DN4 for LANSS for
Form4 patients7 DETECT8 patietns9 physicians7 physician9

Question / 9 9 9 9 9 9 9 9 9 9
pain
descriptor
Number of 10 12 3 7 6 7 9 7 10 7
Questions

Type Assess Discriminate Screen NeP Identify NeP Screen NP Screen NP Screen NP Identify NeP Discriminate Identify NeP
distinct between component NeP from

35
qualities of NeP and in LBP Non-NeP
5

NeP Non-NeP

Intended use Patient Patient Patient Patient Patient Patient Patient Patient Physician Physician
administered administered administered administered administered administered administered administered administered administered
o

NeP = neuropathic pain

35
 6
Thai DN4
r o
n

1. n n ?
n n n
1. o
2.
3.

2. o n n ?

n n n
4. n n
5. o
6. o o
7.

n
3. n n n
n n n
8. oo on
9. oo on

4.
n n n
10. o

n = 1
nn = 0 _______/10
ono n n 4 neuropathic pain
Chaudakshetrin P, Prateepavanich P, Chira-Adisai W, Tassanawipas W, Leechavengvongs S, Kitisomprayoonkul W. Cross-
cultural adaption to the Thai language of the neuropathic pain diagnostic questionnaire (DN4). J Med Assoc Thai 2007;
90:1860-5.

36
36

1
1. Merskey H, Bogduk N. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. 1.
Seattle, WA: IASP Press, 1994: 209-13.
2. Jensen TS, Gottrup H, Sindrup SH, Bach FW. The clinical picture of neuropathic pain. Eur J Pharmacol. 2001; 429:1-11.
3. Treede R-D, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J.
Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology 2008; 70;1630-1635.
4. Bouhassira D, Lanteri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the
general population. 2008;136:380-7.
5. Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from
a general population survey. J Pain 2006; 7:281-9.
6. Hans G, Masquelier E, De Cock P. The diagnosis and management of neuropathic pain in daily practice in Belgium: an
observational study. BMC Public Health 2007; 7:170.
7. Chaudakshetrin P. A survey of patients with neuropathic pain at Siriraj pain clinic. J Med Assoc Thai 2006; 89(3):354-61.
8. Grond S, Radbruch L, Meuser T, Sabatowski R, Loick G, Lehmann KA. Assessment and treatment of neuropathic cancer pain
following WHO guidelines. Pain 1999; 79:15-20.
9. Dubinsky RM, Kabbani H, El-Chami Z, Boutwell C, Ali H. Practice parameter: treatment of postherpetic neuralgia: an evidence-
based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2004; 63:959-65.
10. Jensen TS, Backonja MM, Hernandez Jimenez S, Tesfaye S, Valensi P, Ziegler D. New perspectives on the management of
diabetic peripheral neuropathic pain. Diab Vasc Dis Res 2006; 3:108-19.
11. Kaki AM, El-Yaski AZ, Youseif E. Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds
Assessment of Neuropathic Symptoms and Signs pain scale. Reg Anesth Pain Med 2005; 30:422-8.
12. Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS. Incidence of central post-stroke pain. Pain 1995; 61:187-93.
13. Osterberg A, Boivie J, Thuomas KA. Central pain in multiple sclerosis--prevalence and clinical characteristics. Eur J Pain 2005;
9:531-42.
14. Jan FK, Wilson PE. A survey of chronic pain in the pediatric spinal cord injury population. J Spinal Cord Med 2004; 27Suppl
1:S50-3.
15. Werhagen L, Budh CN, Hultling C, Molander C. Neuropathic pain after traumatic spinal cord injury--relations to gender, spinal
level, completeness, and age at the time of injury. Spinal Cord 2004; 42:665-73.
16. Stevens PE, Dibble SL, Miaskowski C. Prevalence, characteristics, and impact of postmastectomy pain syndrome: an
investigation of women's experiences. Pain 1995; 61:61-8.
17. Werhagen L, Hutling C, Molander C. The prevalence of neuropatihc pain after non-traumatic spinal cord lesion. Spinal Cord 2007;
45:609-15.
18. Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications.
Neurology 2007; 68:1178-82.
19. MeyerRosberg K, Kwanstrom A, Kinnman E, Gordh T, Nordfos LO, Kristofferson A. Peripheral neuropathic pain--a
multidimensional burden for patients. Eur J Pain 2001;5:379-389.
20. Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain
2004; 5:143-9.
21. Taylor RS. Epidemiology of refractory neuropathic pain. Pain Pract 2006; 6:22-6.

2
1. Treede R-D, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J.
Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology 2008; 70;1630-1635.
2. Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain
Scale. Neurology 1997; 48:332-8.
3. Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain 2003; 19:306-14.
4. Backonja MM, Krause SJ. Neuropathic pain questionnaire--short form. Clin J Pain 2003; 19:315-6.
5. Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, et al. Development and validation of the Neuropathic Pain
Symptom Inventory. Pain 2004; 108:248-57.
6. Portenoy R. Development and testing of a neuropathic pain screening questionnaire: ID Pain. Curr Med Res Opin 2006; 22:1555-65.
7. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, 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.

37
37
8. Freynhagen R, Baron R, Gockel U, Tlle TR. painDETECT: a new screening questionnaire to identify neuropathic components in
patients with back pain. Curr Med Res Opin 2006; 22:1911-20.
9. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 2001; 92:147-57.
10. Chaudakshetrin P, Prateepavanich P, Chira-Adisai W, Tassanawipas W, Leechavengvongs S, Kitisomprayoonkul W. Cross-cultural
adaption to the Thai language of the neuropathic pain diagnostic questionare (DN4). J Med Assoc Thai 2007; 90:1860-5.
11. Huskisson EC. Measurement of pain. Lancet. 1974; 2:1127-31.

3
3.1 o
1. Attal N, Cruccu G, Haanp M, Hansson P, Jensen TS, Nurmikko T, Sampaio C, Sindrup S, Wiffen P; EFNS Task Force. EFNS
guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006; 13:1153-69.
2. Attal N, Bouhassira D. Translating basic research on sodium channels in human neuropathic pain. J Pain 2006; 7:S31-7.
3. Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, Bushnell MC, Farrar JT, Galer BS, Haythornthwaite
JA, Hewitt DJ, Loeser JD, Max MB, Saltarelli M, Schmader KE, Stein C, Thompson D, Turk DC, Wallace MS, Watkins LR, Weinstein
SM. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003; 60:1524-34.
4. Dworkin RH, O'Connor AB, Backonja M, Farrar JT, Finnerup NB, Jensen TS, Kalso EA, Loeser JD, Miaskowski C, Nurmikko TJ,
Portenoy RK, Rice AS, Stacey BR, Treede RD, Turk DC, Wallace MS. Pharmacologic management of neuropathic pain: evidence-
based recommendations. Pain 2007; 132:237-51.
5. Eisenberg E, McNicol E, Carr DB. Opioids for neuropathic pain. Cochrane Database Syst Rev 2006; 3:CD006146.
6. Finnerup NB, Otto M, Jensen TS, Sindrup SH. An evidence-based algorithm for the treatment of neuropathic pain. MedGenMed
2007; 9:36.
7. Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: An evidence based proposal.
Pain 2005; 18:289-305.
8. Hansson PT, Dickenson AH. Pharmacological treatment of peripheral neuropathic pain conditions based on shared commonalities
despite multiple etiologies. Pain 2005; 113:251-54.
9. Hollingshead J, Dhmke RM, Cornblath DR. Tramadol for neuropathic pain. Cochrane Database Syst Rev. 2006; 3:CD003726.
10. Jensen TS. Anticonvulsant for neuropathic pain. Eur J Pain 2002; 6;S61-8
11. Markman JD, Dworkin RH. Ion channel targets and treatment efficacy in neuropathic pain. J Pain 2006; 7:S38-47.
12. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev 2007; 4:CD005454.
13. Wiffen P, Collins S, McQuay H, Carroll D, Jadad A, Moore A. Anticonvulsant drugs for acute and chronic pain. Cochrane Database
Syst Rev 2005; 3:CD001133.
14. Wiffen PJ, McQuay HJ, Edwards JE, Moore RA. Gabapentin for acute and chronic pain. Cochrane Database Syst Rev 2005;
3:CD005452.
15. Wiffen PJ, McQuay HJ, Moore RA. Carbamazepine for acute and chronic pain. Cochrane Database Syst Rev 2005; 3:CD005451.
3.2 n
1. Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, Chang YF. Predictors of outcome in surgically
managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J
Neurosurg 2002; 96:527-31.
2. Laghmari M, El Ouahabi A, Arkha Y, Derraz S, El Khamlichi A. Are the destructive neurosurgical techniques as effective as
microvascular decompression in the management of trigeminal neuralgia? Surg Neurol 2007; 68:505-12.
3. Pamir MN, Peker S. Microvascular decompression for trigeminal neuralgia: a long-term follow-up study. Minim Invasive Neurosurg
2006; 49:342-6.
4. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for
trigeminal neuralgia. N Engl J Med 1996; 334:1077-83.
5. Sheehan J, Pan HC, Stroila M, Steiner L. Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J
Neurosurg 2005; 102:434-41.
6. Brisman R. Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings.
Stereotact Funct Neurosurg 2007; 85:94-8.
7. Fountas KN, Smith JR, Lee GP, Jenkins PD, Cantrell RR, Sheils WC. Gamma Knife stereotactic radiosurgical treatment of
idiopathic trigeminal neuralgia: long-term outcome and complications. Neurosurg Focus 2007; 23:E8.
8. Oturai AB, Jensen K, Eriksen J, Madsen F. Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy, and
radiofrequency coagulation. Clin J Pain 1996; 12:311-5.
9. Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic
trigeminal neuralgia: 25-year experience with 1,600 patients. Neurosurgery 2001; 48:524-32.
10. Nuti C, Peyron R, Garcia-Larrea L, Brunon J, Laurent B, Sindou M, Mertens P. Motor cortex stimulation for refractory neuropathic

38 38
 pain: four year outcome and predictors of efficacy. Pain 2005; 118:43-52.
11. Koszewski W, Jarosz J, Pernak-De Gast J. The DREZ lesion as an effective treatment for chronic hypothetically post-herpetic
neuropathic pain. Case report and review of literature. Neurol Neurochir Pol 2003; 37:943-53.
12. Petersen KL, Rowbotham MC. Relief of post-herpetic neuralgia by surgical removal of painful skin: 5 years later. Pain 2007;
131:214-8.
13. Meglio M, Cioni B, Rossi GF. Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg 1989;
70:519-24.
14. Tseng SH. Treatment of chronic pain by spinal cord stimulation. J Formos Med Assoc 2000; 99:267-71.
15. Saris SC, Iacono RP, Nashold BS Jr. Successful treatment of phantom pain with dorsal root entry zone coagulation. Appl
Neurophysiol 1988; 51:188-97.
16. Bittar RG, Kar-Purkayastha I, Owen SL, Bear RE, Green A, Wang S, Aziz TZ. Deep brain stimulation for pain relief: a meta-analysis.
J Clin Neurosci 2005; 12:515-9.
17. Owen SL, Green AL, Nandi DD, Bittar RG, Wang S, Aziz TZ. Deep brain stimulation for neuropathic pain. Acta Neurochir Suppl
2007; 97:111-6.
18. Kumar K, Toth C, Nath RK. Deep brain stimulation for intractable pain: a 15-year experience. Neurosurgery 1997; 40:736-46.
19. Hassantash SA, Afrakhteh M, Maier RV. Causalgia: a meta-analysis of the literature. Arch Surg 2003; 138:1226-31.
20. Johnson JP, Ahn SS, Choi WC, Masciopinto JE, Kim KD, Filler AG, Desalles AA. Thoracoscopic sympathectomy: techniques and
outcomes. Neurosurg Focus 1998; 4:e4.
21. Mailis A, Furlan A. Sympathectomy for neuropathic pain. Cochrane Database Syst Rev 2003; 2:CD002918.
3.3 rg r r
1. Argoff CE, Backonja MM, Belgrade MJ, Bennett GJ, Clark MR, Cole BE, Fishbain DA, Irving GA, McCarberg BH, McLean MJ.
Consensus Guidelines: treatment planning and options. Diabetic peripheral neuropathic pain. Mayo Clin Proc 2006; 81:S12-S25.
2. Moulin DE, Clark AJ, Gilron I, Ware MA, Watson CP, Sessle BJ, et al. Pharmacological management of chronic neuropathic pain-
consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag 2007; 12:13-21.
3. Chen H, Lamer TJ, Rho RH, Marshall KA, Sitzman BT, Ghazi SM, Brewer RP. Contemporary management of neuropathic pain for
the primary care physician. Mayo Clin Proc 2004; 791:1533-1545.
4. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS. EFNS guidelines on
neurostimulation therapy for neuropathic pain. Eur J Neurol 2007; 14:952-70.
5. Corbett CF. Practical management of patients with painful diabetic neuropathy. Diabetes Educ 2005; 31:523-540.
6. Wolfe GI, Hotz SE, Barohn RJ. Treatment of painful peripheral neuropathy. J Clin Neuromusc Dis 2002; 4:50-59.
7. Kowalske KJ, Agre JC. Neuromuscular rehabilitation and electrodiagnosis: generalized peripheral neuropathy. Arch Phys Med
Rehabil 2000;81:S20-S26.
8. Panlilio LM, Christo PJ, Raja SN. Current management of postherpetic neuralgia. Neurologist 2002; 8:339-50.
9. Watson CPN, Oaklander AL. Postherpetic neuralgia. Pain Pract 2002;2:295-307.
10. Brunelli B, Gorson KC. The use of complementary and alternative medicines by patients with peripheral neuropathy. J Neurol Sci
2004; 218:59-66.
11. Dubinsky RM, Kabbani H, El-Chami Z, Boutwell C, Ali H. Practice parameter: treatment of postherpetic neuralgia; An evidence-
based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2004; 63:959-965.
12. Abuaisha BB, Costanzi JB, Boulton AJM. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-
term study. Diabetes Res Clin Pract 1998; 39:115-121.
13. Rapson LM, Wells N, Pepper J, Majid N, Boon H. Acupuncture as a promising treatment for below-level central neuropathic pain:
retrospective study. J Spinal Cord Med 2003; 26:21-26.
14. Chong MS, Bajwa ZH. Diagnosis and treatment of neuropathic pain. J Pain Symptom Manage 2003; 25:S4-S11.

4.
4.1 Diabetic peripheral neuropathy (DPN)
1. Kulkantrakorn K. Diabetic neuropathy: new insights and treatments. Intern Med J Thai 2005;21:286-91.
2. Tapp RJ, Shaw JE, de Courtenm MP, Dunstan DW, Welborn TA, Zimmet PZ, et al. Foot complications in type 2 diabetes: an
Australian population-based study. Diabet Med 2003; 20:105-13.
3. Fedele D, Comi G, Coscelli C, Cucinotta D, Feldman EL, ChirlandaG, et al. A multicenter study on the prevalence of diabetic
neuropathy in Italy. Diabetes Care 1997; 20:836-43.
4. Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M. Natural history of peripheral neuropathy in patients with
non-insulin-dependent diabetes mellitus. N Engl J Med 1995; 333:89-94.
5. Sriussadaporn S, Mekanandha P, Vannasaeng S, Nitiyanant W, Komoltri C, Ploybutr S, Yamwong P, Peerapatdit T, Vichayanrat A.
Factors associated with diabetic foot ulceration in Thailand: a case-control study. Diabet Med 1997; 14:50-6.

39
39
6. Yagihashi S, Yamagishi S, Wada R. Pathology and pathogenetic mechanisms of diabetic neuropathy: correlation with clinical signs
and symptoms. Diabetes Res Clin Pract 2007; 77:S184-89
7. Lauria G, Lombardi R. Skin biopsy: a new tool for diagnosing peripheral neuropathy. BMJ 2007; 334:1159-62.
8. Gabbay KH. Aldose reductase inhibition in the treatment of diabetic neuropathy: Where are we in 2004? Curr Diab Rep 2004; 4:405-
8.
9. Pittinger G, Vinik A. Nerve growth factor and diabetic neuropathy. Exp Diabesity Res 2003; 4:271-85.
10. Casellini CM, Vinik AI. Clinical manifestations and current treatment options for diabetic neuropathies. Endocr Pract 2007; 13:550-66.
11. Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GS, et al. Advances in neuropathic pain: diagnosis,
mechanism and treatment recommendations. Arch Neurol 2003; 100:1524-34.
12. Nolanoa M, Simoneb DA, Wendelschafer-Crabb C , Johnsonc T, Hazenc E, Kennedyc WR. Topical capsaicin in humans: parallel
loss of epidermal nerve fibers and pain sensation. Pain 1999; 81:135145.
13. Vinik A, Ullal J, Parson HK, Casellini CM. Diabetic neuropathies: clinical manifestations and current treatment options. Nat Clin Pract
Endocrinol Metab 2006; 2:269-81.
4.2 Post herpetic neuralgia (PHN)
1. Pavan-Langston D. Herpes zoster antivirals and pain management. Ophthalmology 2008: 115:S13-S20.
2. Opstelten W, EekohoF J, Neven AK, et al . Treatment of herpes zoster. Can Fam Physician 2008; 54:373-377
3. He L, Zhang D, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2008;
1:CD003582.
4. Johnson R, McElhaney J, Pedalino B, Levin M. Prevention of herpes zoster and its painful debilitating complications. Int J Infeut Dis
2007; 11:S43-S48.
5. Tyring SK. Management of herpes zoster and posterpetic neuralgia. J Am Acad Dermatol 2007; 57:S136-S142.

4.3 Trigeminal neuralgia (TGN)

1. Cheshire WP. Trigeminal neuralgia : for one nerve a multitude of treatments. Expert Rev Neurother 2007; 7:1565-79.
2. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management of trigeminal neuralgia. Br J Neurosurg 2007;
21:253-61.
3. Hunt K, Patwardhan R. Trigeminal neuralgia: a modern-day review. Int Rev Neurobiol 2007; 76:621-31.
4. Guo S, Chao ST, Reuther AM, Barnett GH, Suh JA. Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery.
Sterotact Funct Neurosurg 2008; 86:135-146.
5. Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long term
outcomes. Acta Neurochir (Wien) 2008; 150:243-55.
4.4 Phantom limb pain
1. Nikolajsen L, Jensen TS. Phantom pain. In: McMahon SB, Koltzenburg M, eds. Wall and Melzacks textbook of pain, 5th ed. China:
Elsevier, Churchill Livingstone, 2006:961-72.
2. Sherman RA. Postamputation pain. In: Jensen TS, Wilson PR, Rice ASC, eds. Clinical pain management: Chronic pain, 1st ed.
London: Arnold, 2003, 427-36.
3. Woodhouse A. Phantom limb sensation. Clin Exp Pharmacol Physiol 2005; 32:132-4.
4. Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol 2002; 1:182-9.
4.5 Central pain
1. Vranken JH , Dijkgraaf MGW., Kruis MK , van der Vegt MH, Hollmann MW, Heesen M. Pregabalin in patients with central
neuropathic pain: A randomized , double blind , placebo - controlled trial of a flexible - dose regimen . Pain 2008;136:150-157.
2. Dworkin RH, O Connor AB, Backonja M, et al . Phamacologic management of neuropathic pain: Evidence-based recommend-
dations. Pain 2007; 132:237-51.
3. Finnerup NB, Jensen TS. Spinal cord injury pain : mechanisms and treatment. Eur J Neurol 2004;11:73-82
4. Finnerup NB, Otto M, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment : an evidence based proposal. Pain 2005;
118:289-305.

5. Referral criteria
1. Argoff CE, Backonja MM, Belgrade MJ, Bennett GJ, Clark MR, Cole BE, et al. Consensus Guidelines: Treatment Planning and
Options. Mayo Clin Proc 2006;81(Suppl 4):S3-S11.

40 40

(Clinical Practice Guideline for Neuropathic Pain)
.. 2551