Tratamiento del dolor neuropático central; futuras terapias analgésicas. Revisión sistemática

Abstract

Background: The central neuropathic pain (DNC) is that caused by a primary lesion or dysfunction of the central nervous system that generates an incapacitating condition, difficult to recognize and treat. The most common causes are stroke (CVA), multiple sclerosis and spinal cord injury. Objectives: To perform a systematic review of the main causes of central neuropathic pain, present evidence of the effectiveness and tolerability of current treatment options and analyze trends analgesic for future. Material and methods: We performed meta-analysis and search for systematic reviews in MEDLINE/PubMed, EMBASE, Ovid and Cochrane Central Register of Controlled Trials (CENTRAL) using different search strategies. The DNC related articles were classified by etiopathogenesis poststroke pain (CPSP), pain of multiple sclerosis (MS) and pain after spinal cord injury (SCI), and were evaluated systemically. Results: Currently we have an incomplete understanding of the pathophysiology of this type of pain, there are few studies, in comparison with other types of pain, and these studies mostly with small samples, open design in human or animal models. It requires the use of specific and validated assessment instruments specific to each condition, and to include a multi-modal approach to treatment, combining drug therapies, physical, psychological and cognitive behavioral interventions. Conclusions: We need more studies to understand the pathophysiology of the central neuropathic pain, improve the effectiveness of treatments and identify eligible patients each according to clinical characteristics, symptoms or signs predictive, and to investigate new therapeutic modalities, comparing drug reference assets. At present there is not enough solid evidence to perform standardized protocols for treatment of DNC.