http://www.tasp.or.th/neuropathic-pain-2551/

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2. ·π«∑“߇«™ªØ‘∫—µ‘
¿“«–ª«¥‡Àµÿ欓∏‘ ¿“æª√– “∑
(Clinical Practice Guideline for Neuropathic Pain)
π—∫ πÿπ‚¥¬ ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“µ‘
æ.». 2551
ISBN: 978-974-598-056-3
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3. ชื่อหนังสือ
จัดทำโดย
สบับสนุนโดย
ISBN: 978-974-598-056-3
พิมพ์ครั้งที่ 1
ธันวาคม 2551
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พิมพ์ที่
บียอนด์ เอ็นเทอร์ไพรซ์, กรุงเทพฯ
·π«∑“߇«™ªØ‘∫—µ‘
¿“«–ª«¥‡Àµÿ欓∏‘ ¿“æª√– “∑
(Clinical Practice Guideline for Neuropathic Pain)
π—∫ πÿπ‚¥¬ ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“µ‘
æ.». 2551
ISBN: 978-974-598-056-3
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·π«∑“߇«™ªØ‘∫—µ‘
¿“«–ª«¥‡Àµÿ欓∏‘ ¿“æª√– “∑
(Clinical Practice Guideline for Neuropathic Pain)
π—∫ πÿπ‚¥¬ ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ·Ààß™“µ‘
æ.». 2551
ISBN: 978-974-598-056-3
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5. Neuropathic pain “
”
“
”
(general practitioners)
“ ”
. .
ก

6. 1. . .
2. . .
3. . . .
4. . .
5. . .
6. . .
7. .
8. . .
9. . .
10. . .
11. .
12. .
13. . .
14. .
15. .
ข

7. สารบัญ
หน้า
คำนำ ก
รายนามคณะผู้จัดทำ ข
ข้อแนะนำการใช้ CPG
วิธีการสืบค้นข้อมูล
ง
ฉ
บทที่ 1 บทนำ 1
1.1 ลักษณะอาการปวดเหตุพยาธิสภาพประสาท 1
1.2 ระบาดวิทยา 2
บทที่ 2 การวินิจฉัย เครื่องมือ และวิธีติดตามภาวะปวดเหตุพยาธิสภาพประสาท 3
บทที่ 3 การรักษาภาวะปวดเหตุพยาธิสภาพประสาท 7
3.1 การรักษาโดยการใช้ยา 7
3.2 การรักษาโดยการผ่าตัด 12
3.3 การรักษาโดยเวชศาสตร์ฟื้นฟู การแพทย์ผสมผสาน และ การแพทย์ทางเลือก 15
บทที่ 4 การวินิจฉัย และรักษาภาวะปวดเหตุพยาธิสภาพประสาทในโรคที่จำเพาะ 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
4.6 อื่นๆ
25
26
บทที่ 5 เกณฑ์การส่งต่อผู้ป่วย 27
ภาคผนวก 1 คุณภาพหลักฐาน (Quality of evidence) 28
ภาคผนวก 2 หลักการกำหนดน้ำหนักคำแนะนำ 29
ภาคผนวก 3 แนวทางการใช้ระดับหลักฐานประกอบการกำหนดน้ำหนักคำแนะนำ 32
ภาคผนวก 4 ลักษณะของความปวดและการตรวจร่างกาย 33
ภาคผนวก 5 เครื่องมือที่ใช้ในการวินิจฉัยและคัดกรอง 35
ภาคผนวก 6 แบบสอบถาม Thai DN4 36
บรรณานุกรมและเอกสารแนะนำเพิ่มเติม 37
ค

8. CPG
CPG CPG
CPG
(Strength of Recommendation)
++
(cost effective) “ ”
+
“ ”
+/-
“
”
-
“
”
- -
“ ”
(Classification of references)
Level of evidence A systematic review randomized,
controlled clinical trials randomized, controlled
clinical trials
Level of evidence B systematic review controlled clinical
study controlled clinical study (
nonrandomized, controlled trial, cohort study, case-control study,
cross sectional study)
ง

9. randomized, controlled clinical trials
randomized, controlled clinical trials
systematic review randomized, controlled clinical trials
randomized, controlled clinical trials
Level of evidence C systematic review descriptive study
descriptive study
systematic review
controlled clinical study controlled clinical study
controlled clinical trials
Level of evidence D (consensus)
: Level of evidence ( 18 6
. .- . . 2544)
จ

10. /
Medline, Cochrane library, EMBASE 1966
2008 neuropathic pain, epidemiology, assessment,
treatment, diagnosis, guideline, rehabilitation, complementary medicine, alternative
medicine, acupuncture, central pain, post herpetic neuralgia, trigeminal neuralgia, diabetic
peripheral neuropathy
key articles
ฉ

11. 1
1.1
Neuropathic pain
somatosensory system
(lancinating) (burning) (tingling)
(pins and needles) (itching) (paresthesia)
(stimulus- independent pain spontaneous pain)
(stimulus- dependent pain stimulus-evoked pain)
allodynia
hyperalgesia
Neuropathic pain
neuropathic pain
HIV
neuropathic pain
neuropathic pain
(mixed pain)
neuropathic pain
neuropathic pain
diabetic neuropathy, multiple sclerosis
neuropathic pain . . 1994 International
Association for the Study of Pain neuropathic pain neuropathic pain
“ ”1
somatosensory pathways
spino-thalamocortical system
1

12. “ ”
neuropathic pain 2
neuropathic pain
. . 2007 2nd
Congress of Neuropathic Pain
“ somatosensory system”
(Pain arising as a direct consequences of disease affecting the somatosensory system)3
(hyperexcitability)
(plasticity) neuropathic pain neuropathic pain
4
1.2
neuropathic pain
multiple sclerosis
post herpetic neuralgia
spinal cord injury post mastectomy syndrome phantom pain
amputation low back
pain sciatica
neuropathic pain
6.8-8.25,
6 37.8-48
7, 8
369
post
herpetic neuralgia 10-1510
16-2611
low back
pain 54.712
post
stroke pain 813
multiple sclerosis 27.514
13- 38 15, 16, 17
neuropathic pain post mastectomy
syndrome 2018
Neuropathic pain 19
20
neuropathic pain21, 22
2

13. 2
nociceptive, neuropathic, psychogenic
neuropathic pain
(pathognomonic sign)
neuropathic pain
(neuroanatomy)
neuropathic pain
( 2.1 2.1)

14. 2.1 ( 4, 5 6)
( 4)
DN4 ( Thai
DN4 6)
+
1. ++
2. ++
3. ++
4. ,
, ,
++
5. +
6. +
1 2
+ 3-6 1
Neuropathic pain
neuropathic pain
( )
visual analog scale numerical rating scale ++
+/-
+
4

15. NEUROPATHIC PAIN
Definite
Probable
Document of nerve
lesion
Possible
Decreased sensibility in
painful area
Decreased sensibility
in painful area
History of relevant
disease or lesion in
the nervous system
History of relevant
disease or lesion in the
nervous system
History of relevant
disease or lesion in
the nervous system
Pain in neuro-
anatomical area
Pain in neuro-
anatomical area
Pain in neuro-
anatomical area
2.1 neuropathic pain1
neuropathic pain
neuropathic pain
( 2.1) 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)
DN410
( Thai DN4
6)
(quantitative)
neuropathic pain (qualitative)
spontaneous ongoing pain, spontaneous paroxysmal pain,
dysesthesia paresthesia (evoked pains) allodynia
hyperalgesia
1. Visual analogue scale (VAS)
11
VAS 10
5

16. ( 2.2 A)
2. Numerical rating scale (NRS) 11-point Likert scale (0 = no pain, 10 =
worst possible pain) ( 2.2 B)
3. Verbal rating scales (VRS) (
2.2 C)
4. Wong-Baker faces pain rating scale
3 numerical rating scale
( 2.2 D)
0 1-3 4-6 7-10
0 1 2 3 4 5 6 7 8 9 10
A
B
C
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

17. ( 2.3)
2.3
Quantitative Sensory Testing (QST)
allodynia hyperalgesia

18. *
?A
?B
?C
first-line drug
first-line
second-line
( 3.1)
*
A Average pain score VAS NRS 3/10
B Average pain score VAS NRS 4/10 4-8
C Average pain score VAS NRS 30%
4-8
first-line drug
1
( 1)
first-line drug

19. 10
3.1 neuropathic pain
1. First-line medications
1.1 Tricyclic antidepressants
- Amitriptyline + + - -
- Nortriptyline +
(
75
./ )
-
- Imipramine
Enhance
descending
inhibitory
pain pathway
10-75 ./
10-25 .
10-
25 .
1-2
,
,
anticholinergic,
anticholinergic*
- - -
1.2 Calcium channel 2 1 ligands
- Gabapentin Block 2 1
subunit of
calcium
channel
300-3600
./
100-
300 .
100-
300 .
3-7
2-4
, + + +
1.3 Sodium channel blockers
- Carbamazepine 200-1200
./
+ -
- Oxcarbazepine
Block sodium
channel
300-1800
./
+ -
* anticholinergic
10

20. 11
3.1 neuropathic pain ( )
2. Second-line medications
2.1 Tramadol -Weak
agonist
-Enhance
descending
inhibitory pain
pathway
50-400 ./ -
SSRIs
SNRIs
-
+ +/-
SSRIs
SNRIs
TCAs
2.2 Oral morphine agonist -
-
+
tramadol
+/-
2.3 Methadone agonist
NMDA
antagonist
- +
tramadol
morphine
+/-
2.4 Pethidine agonist neuropathic pain - -
2.4 Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Venlafaxine 75-150 ./ + +/-
- Duloxetine*
Enhance
descending
Inhibitory pain
pathway
30-60 ./
tramadol
serotonin
syndrome
+ +/-
2.5 Calcium channel 2 1 ligands
- Pregabalin Block 2 1
subunit of
calcium
channel
75-600 ./ ,
,
+ ++
2.6 Paracetamol, NSAIDs,
COX-2 inhibitors
chronic neuropathic pain - -
* : Duloxetine 31 2549
11

21. 12
3.2 neuropathic pain
neuropathic pain
Burning Lancinating Hyperalgesia Allodynia Paresthesia,
dysesthesia
TCA Amitriptyline + + +/- + + + + +
SNRI Venlafaxine + +/- + + +/-
Duloxetine + + +/- + + + +/-
Sodium channel Carbamazepine +/- + + + + +
blockers Oxcarbazepine +/- + + + + +
Calcium channel Gabapentin + + +/- + + + + +
2 1 ligands Pregabalin + + +/- + + + + +
Opioids Tramadol + +/- + + +
Morphine +/- +/- +/- +/- +/-
3.3 neuropathic pain
neuropathic pain
DPN PHN TGN Phantom
limb pain
Central pain
TCA Amitriptyline + + + + +/- + + +
SNRI Venlafaxine + + - - +/-
Duloxetine + + + - - +/-
Sodium channel Carbamazepine +/- +/- + + + +
blockers Oxcarbazepine +/- +/- + + + +
Calcium channel Gabapentin + + + + +/- + +
2 1 ligands Pregabalin + + + + +/- + +
Opioids Tramadol + + - +/- +/-
Morphine +/- +/- - +/- +/-
DPN: diabetic peripheral neuropathy, PHN: post herpetic neuralgia, TGN: trigeminal neuralgia

22. 13
3.2
3.4 neuropathic pain
1.
2.
3. vascular loop
compression
Microvascular decompression
(MVD)
+ + 68-95%
70 – 95%
72 – 73%
5-6
0.1%
1 %
Gamma knife +/- 47 – 88 % 1
(75 – 92.9 % 1 )
24 – 74 %
18 3 ( 48 –
90% )
10%
SRS
persistent paresthesia (
15.8%
16.3%
Radiofrequency
thermoregulation
+ 83 – 97%
49 – 70%
5-7
Trigeminal neuralgia
1.
2.
Motor cortex stimulation +/- 10% ,
42% , 35%
, 13%
36%
Dorsal root entry zone
(DREZ) dressing
+/-
Spinal cord stimulation +/-
Post herpetic neuralgia 1.
2.
Motor cortex stimulation +/-
DREZ spinal
cord stimulation (60-70% for
DREZ)

23. 14
3.4 neuropathic pain ( )
+/-
For general
traumatic
amputations associated with root
avulsion
Dorsal root entry zone
(DREZ) lesion
- -
Stump pain
phantom
stump pain stump pain
Phantom limb pain 1.
2.
Deep brain stimulation (DBS) +/-
DBS PVG/PAG grey matter
(79%) PVG/PAG plus
sensory thalamus/internal
capsule (87%)
sensory thalamus
(58%
long-term success) (p 0.05)
DBS nociceptive
pain deafferentation pain
(63% vs 47% long-term success;
p 0.01)
3. neuroma +
+/-
Deep brain stimulation +/- Trial stimulation
50%
post-stroke pain
58%
Thalamic pain 1.
2.
Motor cortex stimulation +/- 10%
, 42%
, 35%
, 13%
36%
Causalgia, Sympathetic
mediated pain
1.
2.
Sympathectomy +
sympathetic
block
66-96%
94% sympathectomy

24. 15
3.3
Neuropathic pain
neuropathic pain 2 1
1.
2.
neuropathic pain
RCT
(adjunctive therapy)
15

25. 16
2,3
3.3.1
neuropathic pain 40
5 alternative medicine 36
(acupuncture) 3.5
3.5
/
Patient education ++
TENS (Transcutaneous
Electrical Nerve
Stimulation)
- Hi-TENS (conventional)
Hi frequency, low
intensity
- Lo-TENS (acupuncture-
like) Lo frequency,
Hi intensity
Chronic neuropathic
pain
-
cardiac
pacemaker
-
allodynia
TENS 8
- 9
200
-
-Hi-TENS
,
Lo-TENS
-
-
30
/
-
Hi-TENS
Lo-TENS
trial
error
accommodation
effects of nerve
nerve fiber
4,5,6,7 +
(
)
+/-
- -
Hi-TENS
cardiac
pacemaker
16

26. 17
3.5 ( )
/
Relaxation techniques Neuropathic pain:
Postherpetic neuralgia
peripheral
neuropathy
- - 7,8,17 +
General Exercise
improve general condition
-
(immobilization
syndrome)
-
6,7 ++
Specific exercise +/-
Heat Cold hot
pack, warm bath, ice
Neuropathic pain - burn
sensory impaired
- 7 +/-
- -
sensory deficit
DM
Desensitization Neuropathic pain -
allodynia
- 9 +/-
- -
allodynia
(
)

27. 18
3.3.2
(Complementary
Alternative Medicine: CAM) peripheral neuropathy 43 CAM
(mega-vitamins 35) (magnet 30) ( 30)
( 22) chiropractor ( 21)10
27
CAM neuropathic pain
3.6
18

28. 19
3.6
/
(Acupuncture)
Painful diabetic
neuropathy, central
neuropathic pain in
spinal cord injury
(SCI)
-
-
-
-
HIV,
hepatitis B
-RCT
(postherpetic neuralgia)
placebo,
sham,
- painful
diabetic neuropathy, central
neuropathic pain in SCI
-
-
- 1-3
(10 / )
4-5
5,8,11
1,6,12,13
10,14
+/-
radiculopathy
trigeminal neuralgia
+/-
Central NeP
(SCI) painful
diabetic neuropathy
-
post-herpetic
neuralgia
Painful peripheral
neuropathy
-
neuropathic pain
neuropathic pain
- (balanced
diet)
-
( 1 )
-
-
B6
neuropathy
6,10 +
Balanced diet
+ +
Avoid alcohol
+/-
MTV, B complex, 3B
- -
B6
100 ./ )
- -
Vitamin E 400
U/day
Parkinson’
disease
Alzheimer’s disease
(
)
Mild degree
neuropathic pain
- peripheral
sensitization
-
+/-
19

29. 20
4
4.1 Diabetic neuropathy
1 2
2
1
13.12
32.33
7-13 4
20-33% 10 4
5
3
1. Distal symmetric diabetic polyneuropathy (DSDP)
/ 2
2. Autonomic neuropathy
(autonomic neuropathy)
DSDP
20

30. 21
QT
3. Focal and multifocal neuropathy
truncal radiculoneuropathy,
median, radial, ulnar peroneal nerve (entrapment)
,
(hyperglycemia)
(reactive oxygen
species)
(advanced glycation endproducts AGEs)
polyol pathway protein kinase C
6
2
glucose tolerance test
serum electrophoresis, TSH, BUN, Creatinine
(skin biopsy)
7
Quantitative sensory testing (QST)
21

31. 22
:
aldose
reductase inhibitors nerve growth factor
8,9
: (focal or multifocal neuropathy)
(carbamazepine, gabapentin, pregabalin), antidepressant
(amitryptyline, nortryptyline, duloxetine)10
opioid
tramadol strong opioid
11
topical capsaicin
0.075% neuropathic pain 12
fludrocortisone midodrine
13
4.2 (Post herpetic neuralgia, PHN)
varicella-zoster
2.2-3.4 1,000
20 1
(dermatome)
1-3
(post herpetic neuralgia) PHN
2
acyclovir, valacyclovir famciclovir
72
22

32. 23
PHN1,2
PHN3
amitryptyline
2
PHN
PHN 4
gabapentin pregabalin
TCAs tramadol
1,5
4.3 (Trigeminal neuralgia or Tic douloureux)
5
5.9 3.4 100,000
5
trigeminal ganglion
(sensory function)
2 3 (V2,V3) 1 (V1)
(trigger point)
1
arterial venous
loop 5
MRI brain
demyelination multiple sclerosis meningioma
carbamazepine
100 . 2-3
600-1,200 .
23

33. 24
oxcarbazepine
baclofen, phenytoin, gabapentin, lamotrigine 1-3
(2)
alcohol
ganglion
micro vascular loop decompression (MVD)
Gamma
knife radiosurgery 4
MVD 5
4.4 (Phantom limb pain)
1, 2
phantom sensation
acute just post amputation pain
chronic residual limb pain
phantom phenomena
60-80
(phantom pain)
5-10
(stump pain)
(nerve block)
24

34. 25
(randomized control trial)
(neuropathic pain)
(non invasive
treatment)
(antidepressants) tricyclic
sodium channels calcium channels opioids
randomized controlled trials meta analysis
4.5 Central neuropathic pain
8
40
spinothalamic pathway
neuronal excitability
central neuropathic pain
randomized controlled
trial
1. Central neuropathic pain, post stroke : TCA
2. Spinal cord injury pain: calcium channel 2 1 ligands pregabalin
3. Pain associated with multiple sclerosis: cannabinoids (level B)
4. Central neuropathic pain : pregabalin, TCAs, lamotrigine, gabapentin (level B)
25

35. 26
first second line peripheral neuropathic pain
4.6
(mixed pain) neuropathic pain
neuropathic pain neuropathic pain
neuropathic pain
Cancer pain: neuropathic pain
opioids gabapentin, pregabalin, TCAs,
SNRIs antiepileptics
Painful polyneuropathy
o HIV neuropathy antiretrovirals
CYP450 CYP450
gabapentin
o Drug-induced neuropathy
o Guillain–Barre syndrome gabapentin carbama-
zepine opioids
Nerve injury pain radicular pain (include back pain), post-traumatic/post-
surgical neuropathic pain complex regional pain syndromes (CRPS)
paracetamol NSAIDs
neuropathic pain
neuropathic pain
neuropathic pain
26

36. 27
5
neuropathic pain
(chronic pain)
/
1. neuropathic pain
2.
3 50
7/10
3. first-line drugs 2
strong opioids
4. invasive techniques /
5. 1 /
(chronic pain syndrome)
5.1
5.2
5.3
5.4
5.5
5.6
5.7
27

37. 28
1
(Quality of Evidence)
1
1.1 (systematic review) -
(randomize-controlled clinical trials)
1.2 - 1 (a well-designed,
randomize-controlled, clinical trial)
2
2.1 (non-randomized, controlled,
clinical trials)
2.2 (well-designed, non-randomized, controlled
clinical trial)
2.3 (cohort)
(case control analytic studies)
/
2.4 (multiple time series)
. .
2480
3
3.1 (descriptive studies)
3.2 (fair-designed, controlled clinical trial)
4
4.1 (consensus)
4.2 2
(anecdotal report)
28

38. 29
2
“ (strength of recommendation)”
(prolonged life)
(decreased morbidity) (improved quality of life)
(
/ ) “ ”
1 “++” “++”
1
(
50 “+/-”)
Papanicolaou “++”
2
CT / MRI brain “++”
(
“+/-”) “+/-” :-
1.
2.
3.
4.
29

39. 30
5.
12
(systematic review and
consensus of peer reviewers)
/
“5 ”
(1)
(2)
(3) / ( )
“5 ”
(1) (safety)
(2) (efficacy)
(3) (effectiveness)
(4) (benefit of population and entire society)
(5) (efficiency)
1. (safety)
(safety
monitoring program: SMP) ( NNH: number needed to
harm)
2. (efficacy)
/
30

40. 31
( NNT: number
needed to treat)
3. (effectiveness)
/ /
/
3.1
3.2
3.3
3.4
4. (benefit of population and entire society)
/
(utility)
5. (efficiency) 4
31

41. 32
3
:-
1. “++”, “--” /
/ ( )
2 :-
1.1. 1 : - (randomize-controlled, clinical trial)
1
1.2. 2 : (non-randomized, controlled, clinical trial)
2
1.2.1. (cohort)
1.2.2. (case-control)
1.2.3. (multiple-time series) adrenaline
2. “+”, “-” /
/ ( )
( ) / /
1 :-
2.1. 1 ( 1 1 , 2 2 )
2.2. 3 / 4
3. “+/-”
( ) :-
3.1. ( )
3.1.1.
3.1.2.
3.1.3. (surrogated end-point)
3.1.4. (safety monitoring program : SMP)
3.1.5. .
3.2. ( 1 / 2)
3.3. .
3.4. (ultimate end points)
3.5.
32

42. 33
4
Neuropathic pain 2
1. (stimulus-independent spontaneous pain)
(burning) (intermittent shooting),
(lancinating sensations), (electric shock-like pain)
(tingling) “paresthesias”
“dysesthesias”
2. (stimulus-dependent stimulus-evoked pain)
“Hyperalgesia”
(mechanical) (thermal)
(chemical)
“Allodynia”
Mechanical allodynia
(
1A)
Thermal allodynia
40 ( 1B)
neuropathic pain
( 2)
1.
2. (pinprick sense)
3.
4. (tuning fork) 128-Hz
33

43. 34
1 neuropathic pain
A
B
2

44. 35
5
LANSSfor
physician9
7
IdentifyNeP
Physician
administered
DN4for
physicians7
10
Discriminate
NePfrom
Non-NeP
Physician
administered
LANSSfor
patietns9
7
IdentifyNeP
Patient
administered
Pain
DETECT8
9
ScreenNP
component
inLBP
Patient
administered
DN4for
patients7
7
ScreenNP
Patient
administered
IDPAIN6
6
ScreenNP
Patient
administered
NPSI5
7
IdentifyNeP
Patient
administered
NPQShort
Form4
3
ScreenNeP
Patient
administered
NPQ3
12
Discriminate
between
NePand
Non-NeP
Patient
administered
NPS2
10
Assess
distinct
qualitiesof
NeP
Patient
administered
neuropathicpain
Question/
pain
descriptor
Numberof
Questions
Type
Intendeduse
NeP=neuropathicpain
35

45. 36
6
Thai DN4
1. ?
1.
2.
3.
2. ?
3.
4.
4 neuropathic pain
4.
5.
6.
7.
8.
9.
10.
= 1
= 0 _______/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 questionnaire (DN4). J Med Assoc Thai 2007;
90:1860-5.
36

46. 37
1
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4. Bouhassira D, Lanteri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the
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5. Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from
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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
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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;
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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;
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18. Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications.
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19. Meyer–Rosberg 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.
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47. 38
8. Freynhagen R, Baron R, Gockel U, Tölle 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
1. Attal N, Cruccu G, Haanpää 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, Dühmke 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
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

48. 39
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
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

49. 40
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; 81:135–145.
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 Melzack’s 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

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