Managing neuropathic pain (original) (raw)

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.

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 ...

Contemporary Management of Neuropathic Pain for the Primary Care Physician

Mayo Clinic Proceedings, 2004

Neuropathic pain (NP), caused by a primary lesion or dysfunction in the nervous system, affects approximately 4 million people in the United States each year. It is associated with many diseases, including diabetic peripheral neuropathy, postherpetic neuralgia, human immunodeficiency virus-related disorders, and chronic radiculopathy. Major pathophysiological mechanisms include peripheral sensitization, sympathetic activation, disinhibition, and central sensitization. Unlike most acute pain conditions, NP is extremely difficult to treat successfully with conventional analgesics. This article introduces a contemporary management approach, that is, one that incorporates nonpharmacological, pharmacological, and interventional strategies. Some nonpharmacological management strategies include patient education, physical rehabilitation, psychological techniques, and complementary medicine. Pharmacological strategies include the use of first-line agents that have been supported by randomized controlled trials. Finally, referral to a pain specialist may be indicated for additional assessment, interventional techniques, and rehabilitation. Integrating a comprehensive approach to NP gives the primary care physician and patient the greatest chance for success.

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.

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...

Concept and Overview of Neuropathic Pain

2018

Neuropathic pain is defined as pain arising from a lesion or disease of the somatosensory nervous system. It is highly prevalent, afflicting 7–18% of the general population. Its incidences are much higher, ranging from 20% to 77%, in patients with spine disorder, hip and knee osteoarthritis, or cancer. Neuropathic pain can be severely disabling, with significant personal, societal, and economic cost. Patients with neuropathic pain disorders have significantly reduced health-related quality of life and their treatment costs three times that for matched control subjects. There are enormous challenges in understanding and managing neuropathic pain given the diversity of causes, pathology, mechanisms, and clinical presentations of neuropathic pain conditions. Along with these challenges are opportunities for advancing the mechanistic understanding of neuropathic pain and developing promising therapeutic modalities that include new pharmacological agents, emerging stem cell therapy, and ...