[Diagnosis and treatment of the neuropathic pain] (original) (raw)
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Neuropathic Pain: Mechanism, Representation, Management and Treatment
International Clinical Neuroscience Journal
Despite the development of screening tests and diagnostic tools, neuropathic pain is still identified as an underdiagnosed condition lacking proper epidemiological studies. It is difficult to estimate its incidence and prevalence the population. The objective of this narrative review is to summarize current knowledge concerning complications. The underlying mechanisms have also been reviewed in the development of diagnostic or treatment strategies in patients with neuropathic pain to investigate its unique symptoms. The main focus is concentrated on expansion of possible therapeutic options for neuropathic pain treatment. Many therapies are not effective and this often leads to a significant deterioration in the patients’ quality of life. So, the crucial and strategic role of therapeutics in guiding patients in the right direction should not be overlooked. The existing knowledge is so limited and has safety risks. It is truly important to provide alternative treatment strategies in ...
Diagnosis and treatment of neuropathic pain
Current Opinion in Anaesthesiology, 2005
Purpose of review Neuropathic pain accounts for 25-50% of pain clinic visits with an estimated prevalence of 4 million. Neuropathic pain is often difficult to diagnose and treat with few pharmacologic options currently available. This review summarizes the latest research on the pathophysiology, diagnosis and treatment of neuropathic pain. Recent findings The diagnosis of neuropathic pain relies on an evaluation of information given by the patient and physical findings obtained by the health provider. There are several validated questionnaires that can be used. Neuropathic pain is associated with a number of different cellular and molecular mechanisms. These include abnormalities in ion channels; exaggerated responses to cytokines, enzymes and neuropeptides; and abnormal communications between large/small fibers and sympathetic/small fibers. An understanding of these mechanisms has led to mechanistic directed treatments including topical treatments, antiepileptics, antidepressants, opioids and other drugs in development that are more mechanistically driven. Summary Neuropathic pain is common, underdiagnosed and undertreated. Diagnosing and understanding the basic mechanisms of neuropathic pain will lead to better treatments of this difficult health care problem.
Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment
The Lancet Neurology, 2010
Neuropathic pain develops as a result of lesions or disease aff ecting the somatosensory nervous system either in the periphery or centrally. Examples of neuropathic pain include painful polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, and post-stroke pain. Clinically, neuropathic pain is characterised by spontaneous ongoing or shooting pain and evoked amplifi ed pain responses after noxious or non-noxious stimuli. Methods such as questionnaires for screening and assessment focus on the presence and quality of neuropathic pain. Basic research is enabling the identifi cation of diff erent pathophysiological mechanisms, and clinical assessment of symptoms and signs can help to determine which mechanisms are involved in specifi c neuropathic pain disorders. Management of neuropathic pain requires an interdisciplinary approach, centred around pharmacological treatment. A better understanding of neuropathic pain and, in particular, of the translation of pathophysiological mechanisms into sensory signs will lead to a more eff ective and specifi c mechanism-based treatment approach.
Pharmacological management of neuropathic pain in non-specialist settings: summary of NICE guidance
BMJ, 2010
Context: Neuropathic pain (NP) is a chronic debilitating painful condition with complex pathophysiology and inadequate treatment. Conventional pharmacological approaches and currently available drugs only provide marginal pain relief and cause significant adverse effects. The present manuscript is an attempt to summarize the existing data and possible pharmacological approaches available for NP. Evidence Acquisition: Information was collected from Google Scholar, Cochrane and PubMed databases, Scopus and directory of open access journals. Neuropathic pain, chronic pain, diabetic neuropathy, pathophysiology and current recommendations were the terms used to search the literature. Data from relevant animal and randomized controlled studies were selected to get the up to date information of the currently available pharmacological approaches. A note on future approaches was added based on the recent animal and human studies. Results: The current review made a significant attempt to focus on the mode of action, required dosage, advantages and the side effect profiles of currently available drugs used, or investigational phases and their possible combinations to manage NP. Efforts are made to cover arise of NP because of diabetes and its management. At the end, authors made an attempt to cover the various therapeutic options that are currently explored for future drug development. Conclusions: The available pharmacological approaches are effective on one or other types of chronic pain. But the inadequate pain relief and limitations with each class of drugs raises the need to develop better therapeutic approaches and also understand the pathology better. The present review may be helpful to researchers intending to focus on newer therapeutic strategies and targets to manage NP.
Neurologia i neurochirurgia polska, 2014
Neuropathic pain may be caused by a variety of lesions or diseases of both the peripheral and central nervous system. The most common and best known syndromes of peripheral neuropathic pain are painful diabetic neuropathy, trigeminal and post-herpetic neuralgia, persistent post-operative and post-traumatic pain, complex regional pain syndrome, cancer-related neuropathic pain, HIV-related neuropathic pain and pain after amputation. The less common central pain comprises primarily central post-stroke pain, pain after spinal cord injury, central pain in Parkinson disease or in other neurodegenerative diseases, pain in syringomyelia and in multiple sclerosis. 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 various types of neuropathic pain, with special focus on the available international guidelines, and has formulated recommendations on their diagnosis and treat...
Overview of the Pharmacological Management of Neuropathic Pain
Research in Pharmacy and Health Sciences, 2016
Neuropathic pain refers lesions or disease affecting the somatosensory nervous system either in the periphery or centrally. Examples of neuropathic pain include painful polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, and post-stroke pain. Clinically, neuropathic pain is characterized by spontaneous ongoing or shooting pain and evoked amplified pain responses after noxious or non-noxious stimuli.neuropathic pain is treated as a 'blanket condition' in this guideline regardless of its aetiologies, unless there is valid and robust clinical and health economics evidence that shows the clinical efficacy and cost effectiveness of a particular treatment for a specific neuropathic pain condition. Management of neuropathic pain requires an interdisciplinary approach, centeredaround pharmacological treatment. A better understanding of neuropathic pain and in particular of the translation of pathophysiological mechanisms into sensory signs will lead to a more effective and specific mechanism-based treatment approach.
A glimpse into the pathophysiology, mechanisms, and management of neuropathic pain
National Journal of Physiology, Pharmacy and Pharmacology, 2015
One of the most frequent problems in medical care is the management of patient presenting with chronic pain. Neuropathic pain is related to the injury or disorders affecting peripheral and central nervous systems and is resistant to over-the-counter analgesics and conventional treatment methods. The estimated prevalence for patients presenting classical symptoms of neuropathic pain is eventually reported to be 6%-8%. Several mechanisms have been considered and proposed for this disorder. The involvement of small and large sensory fibers as well as motor fibers is a reason for the presence of neuropathic pain. In addition to the lifestyle modification, a number of different therapeutic approaches and treatment protocols have been applied to control the neuropathic pain. However, management is still unsatisfactory. Comorbidities such as depression, anxiety, and sleep disorders are associated with this disorder and should be previously considered and eliminated. Analgesics, tricyclic antidepressants, anticonvulsant, serotonin-norepinephrine reuptake inhibitors, and local anesthetic agent as well as opioid analgesics and herbal medicaments such as capsaicin are known treatment lines for the management of neuropathic pain. Regarding the unsuccessfulness of single therapy, poly-pharmacy or combination therapy of two or more agents with synergistic mechanisms and different modes of action seems necessary.
Chapter 1 Neuropathic Pain : From Mechanism to Clinical Application
2013
A lesion or disease affecting the somatosensory system can cause a wide range of pathophy‐ siologic symptoms including mild or severe chronic pain. Due to the diversity of etiologies giving rise to nervous system damage that generates neuropathic pain, it has become a ubiquitous health concern without respect for geographic or socioeconomic boundaries [1]. Within the developing world, infectious diseases [2-4] and trauma [5] are the most common sources of neuropathic pain syndromes. The developed world, in contrast, suffers more frequently from diabetic polyneuropathy (DPN) [6, 7], post herpetic neuralgia (PHN) from herpes zoster infections [8], and chemotherapy-induced peripheral neuropathy (CIPN) [9, 10]. There is relatively little epidemiological data regarding the prevalence of neuropathic pain within the general population, but a few estimates suggest it is around 7-8% [11, 12]. Despite the widespread occurrence of neuropathic pain, treatment options are limited and often ineff...
Neuropathic Pain: Incorporating New Consensus Guidelines Into the Reality of Clinical Practice
2004
The recently developed consensus guidelines on the treatment of neuropathic pain reflects our ability to use evidence-based medicine for ratio- nal pharmacotherapy in a group of disorders that is often difficult to treat. Neuropathic pain arises from abnormalities in various points in the ner- vous system and impacts the emotional and psy- chological status of the affected individual. Because no