Neuropathic pain: Review of mechanisms and pharmacologic management

Abstract

Neuropathic pain is a challenge for clinicians because it is resistant to commonly prescribed analgesics, such as opioids and nonsteroidal antiinflammatory drugs. Fortunately, adjuvant analgesics, drugs not typically thought of as pain relievers, may be effective. It is helpful to classify adjuvant analgesics used to treat neuropathic pain into two broad categories: (1) membrane stabilizing agents, which inhibit ectopic discharges on damaged neural membranes, and (2) drugs that enhance dorsal horn inhibition, which may augment biogenic amine or GABAergic mechanisms in the dorsal horn of the spinal cord. Current evidence regarding efficacy generally does not support the use of one drug over another, and selection of a particular drug may depend on experience or expected side effects. The overall efficacy of tricyclic antidepressants for neuropathic pain is modest, and they may produce intolerable side effects. Based on current studies, gabapentin is a reasonable alternative to antidepressants, as initial monotherapy or add-on treatment, particularly for painful diabetic peripheral neuropathy and postherpetic neuralgia. From a practical standpoint, to optimize analgesia more than one drug may be necessary. Although polypharmacy is the result, this approach may improve therapy and minimize side effects. From a safety standpoint, medications generally should be started at low doses and titrated to effect. Although labor-intensive, this strategy can improve compliance and optimize patient care.

Therapeutic Management of Chronic Neuropathic Pain

“…In 2000 and early in 2003, as is demonstrated in 2, treatment strategies and algorithms were published 7,26 . Currently, published guidelines exist for the treatment of neuropathic pain in general, as well as for the management of neuropathic pain associated with specific syndromes, such as painful diabetic neuropathy 27,28 and trigeminal neuralgia 29 .…”

Electroacupuncture Modulates Spinal BDNF/TrκB Signaling Pathway and Ameliorates the Sensitization of Dorsal Horn WDR Neurons in Spared Nerve Injury Rats

“…Neuropathic pain is a type of chronic pain syndrome induced by peripheral or central nervous system injuries, lesions, and dysfunction [ 1 ]. In clinical practice, neuropathic pain is great correlation with hyperalgesia, allodynia, and spontaneous pain [ 2 ], which causes a great burden to patients’ lives mainly by impairing sleep quality and producing adverse emotions, depression, and cognitive disorders [ 3 ].…”

Assessing and Treating Patients With Neuropathic Pain

“…Although many of the therapies previously discussed have been shown to be effective, the proportion of patients who respond favorably is limited, with only one fourth to one third of subjects obtaining significant relief with pharmacotherapy compared with placebo [131,132]. Thus it is critical to identify and aggressively treat all relevant spheres of the pain experience.…”