02143nas a2200349   4500000000100000008004100001260001300042653001100055653002300066653002000089653003700109653002900146653002000175653003200195653001500227653001100242653001300253653001200266653001400278653001400292653002500306653001500331653003600346653002800382653002800410100001500438245007500453300001000528490000700538520123400545022001401779       2008                            d  c2008 Sep10aAmines10aAnalgesics, Opioid10aAnticonvulsants10aAntidepressive Agents, Tricyclic10aCalcium Channel Blockers10aChronic Disease10aCyclohexanecarboxylic Acids10aGabapentin10aHumans10aKetamine10aleprosy10aLidocaine10aNeuralgia10aPosterior Horn Cells10aPregabalin10aReceptors, N-Methyl-D-Aspartate10aSodium Channel Blockers10aGamma-Aminobutyric Acid1 aYamamoto T00a[Mechanisms of the development of neuropathic pain and its treatment].  a215-80 v773 a<p>Neuropathic pain has been known to be refractory to traditional analgesics, such as opioids and non-steroidal anti-inflammatoy drugs. Some mechanisms of the development of neuropathic pain have been proposed; 1) sprouting of A beta fibers to the superficial layer of the dorsal horn, 2) ectopic discharge in the dorsal root ganglion and/or in neuroma at the nerve stump, 3) spinal sensitization. Ectopic discharge has been reported to be inhibited by Na+ channel blocker, such as lidocaine, and anticonvulsant. Lidocaine and anticonvulsant are used in the management of neuropathic pain. Activation of NMDA receptor is usually involved in the development of spinal sensitization and NMDA receptor antagonist, such as ketamine, is used in the management of neuropathic pain. Recently, alpha2delta subunit blocker, new class of anticonvulsant, is introduced to the management of neuropathic pain. alpha2delta subunit is the subunit of Ca2+ channel and modulate the influx of Ca2+. This Ca2+ influx induces release of neurotransmitter in the neuron. alpha 2 delta subunit blockers, such as gabapentin and pregabalin, may reduce the release of neurotransmitter and elicit analgesic effect in the treatment of neuropathic pain.</p>  a1342-3681