Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part one

Abstract

Neuropathic pain still present a major diagnostic and therapeutic challenge despite considerable progress in understanding of its mechanisms and publication of number of studies which assessed the efficacy and safety of drugs used in the symptomatic treatment. In practice, it is diagnosed less frequently than recognised in the epidemiological studies, and many patients do not achieve satisfactory outcomes of treatment. A multidisciplinary team of Polish experts, commissioned by the Polish Association for the Study of Pain and the Polish Neurological Society, has reviewed the literature on neuropathic pain, with special focus on the published international recommendations, and formulated recommendations on neuropathic pain diagnosis and treatment, in accordance with the principles of evidence-based medicine. The paper presents also background information on the neuropathic pain definition, epidemiology, pathomechanism and method of assessment. The diagnosis of neuropathic pain may be established based on medical history and physical examination including special assessment of the somatosensory system. First-line drugs used in pharmacological management of neuropathic pain are: tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, opioids and lidocaine patches.

The RS504393 Influences the Level of Nociceptive Factors and Enhances Opioid Analgesic Potency in Neuropathic Rats

“…Nevertheless, in the neuropathic pain, opioids exhibit lower effectiveness than in other pain conditions (Watkins et al 2005; Szczudlik et al 2014). The mechanism underlying this phenomenon is still poorly understood.…”

Lower Limb Lymphedema and Neurological Complications After Lymphadenectomy for Gynecological Cancer

“…18 Treatments commonly used for NC include tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, opioids, and lidocaine patches. 19 Early start and continued practice could be highly effective.…”

Intrathecal administration of nociceptin/orphanin FQ receptor agonists in rats: A strategy to relieve chemotherapy-induced neuropathic hypersensitivity

“…gabapentin and pregabalin) and topical lidocain (Szczudlik et al, 2014). The available meta-analysis of the role of opioids in the treatment of chronic non-cancer pain does not evaluate CIPN (Eisenberg et al, 2014;Furlan et al, 2006;McNicol et al, 2013) and persistent controversy surrounds the use of opioid analgesics in neuropathic pain (Dellmijn, 1999).…”