Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism-based approach.

tection and vibratory detection thresholds also significantly increased with HFS compared to ON states (p = 0.04 and p = 0.01, respectively). In addition, HFS significantly decreased 10-and 40-gram pinprick detection compared to OFF states (both p = 0.01). No significant differences between OFF, ON and HFS states were seen in thermal and thermal pain detection. Conclusion: HFS is a new means of modulating chronic pain. The mechanism by which HFS works seems to differ from that of traditional SCS, offering a new platform for innovative advancements in treatment and a greater potential to treat patients by customizing waveforms.

Multidrug therapy (MDT) has been widely accepted and used as a standard of practice in most areas of medical practice, including neuropathic pain. Because neuropathic pain is a new field of medical science and practice, standards for its treatment including MDT are still evolving. In this article, we present rationale and principals for the MDT of neuropathic pain based on our best understandings of the underlying mechanisms of the disease processes and the actions of drugs, the goal being to maximize benefits and minimize adverse effects. MDT for neuropathic pain is based on a comprehensive clinical neuropathic pain assessment and ongoing monitoring of the drug therapy's efficacy and adverse effects, administering one drug at the time.

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