lossignol d - congrès amub 2017 · figure 1. (a) nav channel structural topology. domains d1–d4...
TRANSCRIPT
![Page 1: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/1.jpg)
LOSSIGNOL D - Congrès AMUB 2017 1
![Page 2: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/2.jpg)
Gestion de la douleur neuropathique
Dr Dominique LossignolMédecine interne
Unité des soins supportifsInstitut Jules Bordet
51e CONGRES DE L’A.M.U.B.
Session NEUROLOGIE
Modérateurs :
Drs M. Hanset – M. Pandolfo – P.J. Schellens
Jeudi 7 septembre 2017
LOSSIGNOL D - Congrès AMUB 2017 2
![Page 3: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/3.jpg)
Conflits d’intérêt en rapport avec la
présentation
Aucun
LOSSIGNOL D - Congrès AMUB 2017 3
![Page 4: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/4.jpg)
Définition et évaluation de la
douleur neuropathique Définition de la douleur (IASP)
Douleur neuropathique
Douleur neurogène
Douleur non-nociceptive
Associées/Assimilées aux douleurs réfractaires, parfois aux acccès douloureux paroxystiques (ADP)
Prévalence:
entre 6.9 et 10% au sein de la population générale en fonction de la pathologie sous jacente
17% dans les cas de douleurs chroniques avec composante neuropathique
26% des personnes de plus de 65 ans vont développer une neuropathie, sans facteur prédisposant
Ce n’est pas vraiment une affaire de neurologues…
LOSSIGNOL D - Congrès AMUB 2017 4
![Page 5: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/5.jpg)
LOSSIGNOL D - Congrès AMUB 2017 5
![Page 6: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/6.jpg)
Physiopathologie
LOSSIGNOL D - Congrès AMUB 2017 6
![Page 7: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/7.jpg)
Questionnaires DN 4
ID Pain
LANSS
Mc Gill Questionnaire
Ne peuvent se substituer à l’examen clinique
Confirment ce que le clinicien sait déjà.
Voir le site de la SFETD
LOSSIGNOL D - Congrès AMUB 2017 7
![Page 8: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/8.jpg)
LOSSIGNOL D - Congrès AMUB 2017 8
![Page 9: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/9.jpg)
LOSSIGNOL D - Congrès AMUB 2017 9
![Page 10: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/10.jpg)
LOSSIGNOL D - Congrès AMUB 2017 10
![Page 11: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/11.jpg)
Caractéristiques Elancements, sensations de brûlure, picotements,
fourmillements, sensation de crampes, intolérance au contact du chaud ou du froid, etc.
Richesse sémantique selon les cas
Distribution en « gants et en bas (stocking) » dans certains cas
Allodynie, hyperalgie
Impotence fonctionnelle inconstante
Atteinte du système nerveux autonome
LOSSIGNOL D - Congrès AMUB 2017 11
![Page 12: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/12.jpg)
Etiologies (« De A à Z ») Diabète sucré (neuropathie parfois révélatrice)
Polyol pathway
PARP Pathway
Alcool
Carence en thiamine
Toxicité directe
Médicaments
Chimiothérapie (Vinka alcaloïdes, platine,… thalidomide, bortézomib…)
Statines
Amiodarone
…
Affections néoplasiques
Rôles des endothélines
Herpès
Lésion spinale
LOSSIGNOL D - Congrès AMUB 2017 12
![Page 13: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/13.jpg)
LOSSIGNOL D - Congrès AMUB 2017 13
![Page 14: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/14.jpg)
LOSSIGNOL D - Congrès AMUB 2017 14
![Page 15: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/15.jpg)
Douleurs neuropathiques et cancerSyndrome Effet
direct
Iatrogène Paranéoplasique Infection
Polyneuropathie + +++ + -
Mononeuritis +++ + - ++
Plexopathie +++ ++ - -
Nerfs craniens +++ +/- - ++
Lésions radiculaires +++ + - +
Lésions médullaires + +/-
+
+/- -
Lésions cérébrales +++ ++ - +
LOSSIGNOL D - Congrès AMUB 2017 15
![Page 16: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/16.jpg)
Echelle OMS (modifiée depuis 1986)
LOSSIGNOL D - Congrès AMUB 2017 16
![Page 17: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/17.jpg)
Traitements Dépend en partie du type de lésion ou de l’agent
causal
Rôle des récepteurs NMDA (N méthyl-D-Aspartate),
des canaux sodium, des canaux calciques (en
particulier la sous unité Cavα2δ1)
LOSSIGNOL D - Congrès AMUB 2017 17
![Page 18: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/18.jpg)
Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in
gray. Transmembrane segments (S1–S6) labelled together with graphical representation of P-loops. (b) Side view; (c) Top view of
volta...
Sharan K. Bagal, Mark L. Chapman, Brian E. Marron, Rebecca Prime, R. Ian Storer, Nigel A. Swain
Recent progress in sodium channel modulators for pain
Bioorganic & Medicinal Chemistry Letters, Volume 24, Issue 16, 2014, 3690–3699
http://dx.doi.org/10.1016/j.bmcl.2014.06.038
LOSSIGNOL D - Congrès AMUB 2017 18
![Page 19: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/19.jpg)
Figure 15. Nav channel modulators in clinical development for the treatment of pain.
Sharan K. Bagal, Mark L. Chapman, Brian E. Marron, Rebecca Prime, R. Ian Storer, Nigel A. Swain
Recent progress in sodium channel modulators for pain
Bioorganic & Medicinal Chemistry Letters, Volume 24, Issue 16, 2014, 3690–3699
http://dx.doi.org/10.1016/j.bmcl.2014.06.038
Douleurs réfactaires D Lossignol 2017
![Page 20: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/20.jpg)
Co-analgesiques Antiépileptiques (carbamazepine, valproate,
gabapentine, pregabaline)
Antidépresseurs (amitriptyline, trazodone, venlaflaxine, sertraline)
Myorelaxants (diazepam, clonazepam, midazolam)
Cannabinoïdes
Stéroïdes
Autres: biphosphonates, amphétamine,
LOSSIGNOL D - Congrès AMUB 2017 20
![Page 21: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/21.jpg)
Anti dépresseurs Amitriptyline/ Nortriptyline
Expérience dans la neuropathie diabétique
« Extension » des indications aux douleurs neuropathiques
(avec troubles du sommeil)
Inhibition de la recaptation de la sérotonine et de la
noradrénaline, interaction avec les récpteurs NMDA et les
canaux sodiqes.
25-50 mg/ 10 mg
Toxicité/ Effets secondaires/Interactions avec les
morphiniques !
LOSSIGNOL D - Congrès AMUB 2017 21
![Page 22: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/22.jpg)
Anti dépresseurs Duloxétine
(Cymbalta®)
Pas de donnée concernant les douleurs cancéreuses
Effets secondaires/ Interaction avec le Cyp 1A2
30 mg/J
LOSSIGNOL D - Congrès AMUB 2017 22
![Page 23: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/23.jpg)
Anti épileptiques Carbamazépine:
« Tricyclique »
Expérience dans la névralgie du trijumeau
« Extension » des indications à toutes les douleurs
neuropathiques
400 mg
Toxicité
LOSSIGNOL D - Congrès AMUB 2017 23
![Page 24: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/24.jpg)
Anti épileptiques
Clonazepam (Rivotril): status epilepticus, douleur
neuropathique
Effet essentiellement anxiolytique
0.5 mg/J
LOSSIGNOL D - Congrès AMUB 2017 24
![Page 25: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/25.jpg)
Gabapentine
Pharmacokinetics:
Peak level after 2 à 3 hours
Bioavailability of 55 %
No binding to serum proteins
CSF concentration is about 20 % of the plasma level
No liver metabolism
Half life: 5 to 7 hours
Few side effects
Low price…
LOSSIGNOL D - Congrès AMUB 2017 25
![Page 26: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/26.jpg)
Prégabaline
Pharmacokinetics:
Peak level after 1 hour
Bioavailability of 90 %
No binding to serum proteins
CSF concentration is about 20 % of the plasma level
No liver metabolism
Half life: 5.5 to 6.7 hours
Few side effects
Quality of sleep
LOSSIGNOL D - Congrès AMUB 2017 26
![Page 27: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/27.jpg)
Gabapentin and Pregabalin for Pain — Is Increased
Prescribing a Cause for Concern?
Christopher W. Goodman, M.D., and Allan S. Brett, M.D.
N Engl J Med 2017 August 2017 DOI:
10.1056/NEJMp1704633
LOSSIGNOL D - Congrès AMUB 2017 27
![Page 28: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/28.jpg)
LOSSIGNOL D - Congrès AMUB 2017 28
![Page 29: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/29.jpg)
LOSSIGNOL D - Congrès AMUB 2017 29
![Page 30: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/30.jpg)
LOSSIGNOL D - Congrès AMUB 2017 30
![Page 31: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/31.jpg)
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain — United States, 2016. JAMA 2016;315:1624-1645CrossRef | Web of Science | Medline
Medicines use and spending in the U.S. — a review of 2016 and outlook to 2021. Parsippany, NJ: IMS Institute for Healthcare Informatics, 2017 (https://structurecms-staging-psyclone.netdna-ssl.com/client_assets/dwonk/media/attachments/590c/6aa0/6970/2d2d/4182/0000/590c6aa069702d2d41820000.pdf?1493985952).
Steinman MA, Bero LA, Chren M-M, Landefeld CS. Narrative review: the promotion of gabapentin: an analysis of internal industry documents. Ann Intern Med 2006;145:284-293CrossRef | Web of Science | Medline
Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med 2017;376:1111-1120Full Text | Web of Science | Medline
Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs 2017;77:403-426CrossRef | Web of Science | Medline
LOSSIGNOL D - Congrès AMUB 2017 31
![Page 32: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/32.jpg)
Benzodiazépines Diazepam (Valium):Phénomènes spastiques
5-10 mg
Clonazepam (Rivotril):
0.5 mg
Midazolam (Dormicum): Sédation, symptômes
réfractaires
1-3 mg/h SC
LOSSIGNOL D - Congrès AMUB 2017 32
![Page 33: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/33.jpg)
LOSSIGNOL D - Congrès AMUB 2017 33
![Page 34: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/34.jpg)
Les morphiniques Oxycodone
Tramadol
Buprénorphine
Méthadone
…
Morphine
LOSSIGNOL D - Congrès AMUB 2017 34
![Page 35: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/35.jpg)
Steroïdes Usage répandu
Peu d’études contrôlées
Compression médullaire, plexopathie
Métastases hépatiques
Prednisolone
32-96 mg /d
Dexaméthasone
4-16 mg/d
LOSSIGNOL D - Congrès AMUB 2017 35
![Page 36: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/36.jpg)
Cannabinoïdes
THC
Cannabidiol
LOSSIGNOL D - Congrès AMUB 2017 36
![Page 37: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/37.jpg)
Journal of Pain and Symptom Management 2011 41, 768-778DOI: (10.1016/j.jpainsymman.2010.06.016)
Copyright © 2011 U.S. Cancer Pain Relief
LOSSIGNOL D - Congrès AMUB 2017 37
![Page 38: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/38.jpg)
Journal of Pain and Symptom Management 2011 41, 768-778DOI: (10.1016/j.jpainsymman.2010.06.016) LOSSIGNOL D - Congrès AMUB 2017 38
![Page 39: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/39.jpg)
Pharmacologie
Davison S. .JPSM Volume 41, Issue 4, Pages 768–778
LOSSIGNOL D - Congrès AMUB 2017 39
![Page 40: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/40.jpg)
Prévention Conceptuellement simple, pratiquement impossible
Chimiothérapie
Amifostine
Calmangafodipir
Vitamine E
L Carnitine
LOSSIGNOL D - Congrès AMUB 2017 40
![Page 41: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/41.jpg)
Approche (propositions)• Identifier la ou les causes de la douleur
• Relever les traitements reçus et ou les conditions médicales susceptibles de provoquer des douleurs neuropathiques et si possible y remédier
• Evaluer les traitements en cours, et pas seulement les antalgiques
• Utiliser le DN4 ou un autre questionnaire validé dans un but propédeutique et référentiel
• Réaliser un examen neurologique approfondi
• Evaluer les contre-indications éventuelles à l’administration des médicaments et informer le patient des effets secondaires possibles.
• S’il n’y pas de contre-indication, instaurer la gabapentine ou la prégabaline. L’accord du médecin conseil n’est pas (plus) requis.
• S’il n’y a pas d’effet secondaire ou de signe d’intolérance, et en cas de réponse clinique favorable, maintenir le traitementtout en le réévaluant. Majorer la posologie en cas d’absence de réponse optimale.
• Dans le cas contraire (effets secondaires, intolérance) passer une autre molécule en fonction de la première prescrite (prégabaline ou gabapentine).
• S’il n’y a pas de réponse favorable, proposer la duloxétine (deuxième ligne) ou un dérivé morphinique comme le tramadolou l’oxycontin (troisième ligne)
• Evaluer la possibilité d’un traitement topique (emplâtre de lidocaïne)
• En toute circonstance, évaluer la situation régulièrement
LOSSIGNOL D - Congrès AMUB 2017 41
![Page 42: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/42.jpg)
Conclusions Les douleurs neuropathiques constituent une entité
complexe et hétérogène et qui demandent une
approche spécifique.
Les traitements disponibles concernent une grande
variété de médicaments dont aucun n’est spécifique.
La préférence ira vers des molécules ayant le moins
d’effets secondaires.
Les moyens de préventions sont limités
LOSSIGNOL D - Congrès AMUB 2017 42
![Page 43: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/43.jpg)
Références (Voir RMB) Société française d’étude et de traitement de la douleur (SFETD) : http://www.sfetd-douleur.org/la-douleur-neuropathique (dernière consultation le 1er mai 2017
Van Hecke O, Austin SK, Khan RA et al. Neuropathic pain in the general population : a systematic review. Pain 2014 ; 654-662
Bouhassira D, Attal N, Alchaar H et al. Comparison of pain syndromes associated with nervous somatic lesions and development of a new neuropathic pain
diagnostic questionnaire (DN4). Pain 2005; 114: 29-36
Portenoy R. Development and testing of a neuropathic pain screening questionnaire: ID Pain. Curr Med Res Opin 2006; 22: 1555-1565
Hans G, Masquelier E, De Cock. Diagnosis and management of neuropathic pain in daily practice in Belgium : an observationnal study. BMC Public Health, 2007;
7 :170-182
Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain;1:277-299
Keele KD. The pain chart. Lancet 1948: 6-8
Mathieson S, Maher CG, Terwee CB et al. Neuropathic pain questionnaires have limited measurement properties. A systematic review. J Clin Epidemiol 2015 ; 68 :
957-966
Lossignol D. La douleur est-elle une norme universelle ? Douleur Analg 2012 ; 25 : 186-192
LOSSIGNOL D - Congrès AMUB 2017 43
![Page 44: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/44.jpg)
Références (Suite) Société française d’étude et de traitement de la douleur (SFETD) : http://www.sfetd-douleur.org/sites/default/files/u3349/evaluation/image_bpi.pdf (dernière consultation le 1 mai 2017)
Zeng L, Alongkronrusmee D, van Rijn RM. An integrated perspective on diabetic, alcoholic and drug-induced neuropathy, etiology, and treatment in the US. J Pain Research 2017 ; 10 : 219-228
Hans G, Deseure K, Adriaensen H. Endothelin-1-induced pain and hyperalgesia : a review of pathophysiology, clinical manifestations and future therapeutic options. Neuropeptides 2008 ; 42 :119-132
Smith TP, Haymond T, Smith SN, Sweitzer SM. Evidence for the endothelin system as an emerging therapeutic target for the treatment of chronic pain. J Pain Res 2014; 30 :531-545
Hildebrand J. Neurological complications of cancer chemotherapy. Curr Opin Oncol 2006 ; 18 : 321-324
Calmels P, Mick G, Perrouin-Verbe B, Ventura M. Neuropathic pain in spinal cord injury : identification, classification, evaluation. Ann Phys Rehabil Med 2009 ; 52 :83-102
Siddall PJ, Yezierski RP, Loeser JD. Pain following spinal cord injury :Clinical features, prevalence, and taxonomy. International Association for the Study of Pain (IASP) Newsletter 2000 ; 3 :3-7
Hadley GR, Gayle JA, Ripoll J et al. Post-herpetic neuralgia : a review. Curr Pain Headache Rep 2016 ; 20 : 17-21
Deng Y, Luo L. Fang K, Liu J. Clinical practice guidelines for the management of neuropathic pain : a systematic review. BMC Anaesthesiology 2016 ;16 : 12-21
Hurley RW, Adams MC, Benzon HT. Neuropathic pain : treatment guidelines and updates. Curr Opin Anaesthesiology 2013 ; 26 :580-587
Finnerup NB, Attal N, Houroutounian S et al. Pharmacotherapy for neuropathic pain in adults : a systematic review and meta-analysis. Lancet Neurol 2015 ; 14 :162-173
Rager JB, Schwartz PH. Defending opioid treatment agreement: Disclosure, not promises. Hasting Center Report 2017; 47: 24-33
Johnson JR, Burnell-Nugent M, Lossignol D et al. Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients With Intractable Cancer-Related Pain. J Pain Symptom Manage 2009
Karlson JOK, Ignarro LJ, Lundström I, Jynge P et al. Calmangafodipir (Ca4Mn (DPDP)5 , mangafodipir (MnDPDP) and MnPLED with special reference to their SOD mimétic and therapeutic properties. Drug Discovery Today 2015 ;20 : 411-421
LOSSIGNOL D - Congrès AMUB 2017 44
![Page 45: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/45.jpg)
« L’un des grands services que chaque science peut rendre à nos recherches, c’est de nous inviter, en servant d’introduction, à la quitter pour sa voisine ».
Jules Bordet
LOSSIGNOL D - Congrès AMUB 2017 45
![Page 46: LOSSIGNOL D - Congrès AMUB 2017 · Figure 1. (a) NaV channel structural topology. Domains D1–D4 are represented in different colors while β subunits are shown in gray. Transmembrane](https://reader035.vdocuments.mx/reader035/viewer/2022070617/5d5cd9c488c99395368bced0/html5/thumbnails/46.jpg)
LOSSIGNOL D - Congrès AMUB 2017 46