Despite an increasing number of available therapies, the treatment of neuropathic pain remains a major issue. Systematic reviews and meta-analyses indicate that only a minority of patients with neuropathic pain have an adequate response to pharmacological treatment and that most drugs have dose-limiting side effects. We conducted a systematic review and meta-analysis of randomised controlled trials published in the last five years. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Clinical Trials database (ClinicalTrials.gov). Two authors independently selected studies for inclusion, data extraction, and bias assessment. We identified 39 randomised controlled trials and included 16 in the meta-analysis. Trial outcomes were generally modest even for first-line drugs such as tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, and gabapentinoids. Many drugs acting on new pain targets are currently under development. Clinical data are currently available for sodium channel isoform-specific antagonists, anti-nerve growth factor molecules, and fatty acid amide hydrolase inhibitors.

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管理神经性疼痛的药物治疗选择：系统评价和荟萃分析

尽管可用的疗法数量增加，但是神经性疼痛的治疗仍然是主要问题。系统评价和荟萃分析表明，只有少数患有神经性疼痛的患者对药理学治疗有足够的反应，而且大多数药物都有剂量限制的副作用。我们对过去五年中发表的随机对照试验进行了系统的回顾和荟萃分析。我们在PubMed，EMBASE，Cochrane系统评价数据库和临床试验数据库（ClinicalTrials.gov）中搜索了相关论文。两位作者独立选择了纳入，数据提取和偏倚评估的研究。我们确定了39项随机对照试验，并在荟萃分析中纳入了16项。即使对于三环类抗抑郁药，5-羟色胺-去甲肾上腺素再摄取抑制剂和加巴喷丁类药物等一线药物，试验结果通常也很适中。目前正在开发许多针对新疼痛目标的药物。目前可获得钠通道同工型特异性拮抗剂，抗神经生长因子分子和脂肪酸酰胺水解酶抑制剂的临床数据。