Gabapentin對脊髓損傷患者神經性疼痛的治療

Gabapentin for Treatment of Neuropathic Pain in Patients with Spinal Cord Injury

王昭閔(Chao-Min Wang) ； 王顏和(Yen-Ho Wang)

《台灣復健醫學雜誌》 34卷4期 (2006/12) Pp. 197-208

https://doi.org/10.6315/2006.34(4)01

摘要

脊髓損傷病患除了運動與感覺障礙造成日常生活的不便之外，慢性疼痛也是嚴重影響其生活品質的因素。然而，許多治療方法都無法有效改善病人的疼痛。Gabapentin近年來被廣泛使用在各個領域，尤其是神經性疼痛方面，更是有許多成功的臨床經驗。一般認為gabapentin的止痛效果與N-methyl-Daspartate(NMDA)接受器以及電壓依賴型鈣離子隧道(voltage-dependent calcium channel)有關。NMDA接受器複合體被活化後會讓鈣離子進入神經元，據推測gabapentin對此有拮抗作用。另外，gabapentin與α2δsubunit結合，可阻斷鈣離子經由鈣離子隧道流入細胞，減少刺激性物質產生，降低疼痛感，不過目前仍無法確定其真正的作用機轉。Gabapentin只有口服劑型，每天服用900 至3600 mg，分三次投予。副作用以嗜睡與頭暈為主，大部分病患可以忍受。脊髓損傷患者服用藥物後，疼痛得以大幅度減輕，睡眠品質也獲得改善。Gabapentin安全性高，使用方便，效果顯著，臨床試驗亦建議為脊髓損傷後疼痛的第一線治療用藥。

關鍵字

gabapentin ； 脊髓損傷 ； 疼痛

並列摘要

The patients with spinal cord injury suffer from motor and sensory impairment with bowel and bladder dysfunction. However, chronic neuropathic pain is also a common complaint after spinal cord injury and is usually refractory to many therapies. The exact mechanism of relieving hyperalgesia and allodynia is still unknown, but most believed it is related to N-methyl-D-aspartate (NMDA) receptor and voltage-dependent calcium channel. Gabapentin is supposed to be an antagonist of NMDA receptor complex which mediates an influx of calcium ions when activated. In addition, gabapentin inhibits neuronal calcium influx in a calcium channel by binding to the α2δ subunit of the voltage-dependent calcium channel. The decreased calcium influx reduces excitatory amino acid and mediates analgesic effect. Gabapentin is an antiepileptic agent and it has been found to be effective in many therapeutic conditions, especially in neuropathic pain. Oral doses of gabapentin are administered three times a day due to its short half life and daily dosage is from 900 to 3600 mg. The most common side effects are somnolence and dizziness, but they can be well-tolerated by most patients. There are significant improvements in neuropathic pain, sleep and life quality after gabapentin use. Gabapentin is quite safe, convenient and effective and it is suggested to be the first-line medication for the treatment of chronic neuropathic pain in spinal cord injury patients.

並列關鍵字

gabapentin ； spinal cord injury ； pain