Diagnosis and Treatment of Neuropathic Pain

Abstract

Currently, no consensus on the optimal management of neuropathic pain exists and practices vary greatly worldwide. Possible explanations for this include difficulties in developing agreed diagnostic protocols and the coexistence of neuropathic, nociceptive and, occasionally, idiopathic pain in the same patient. Also, neuropathic pain has historically been classified according to its etiology (e.g., painful diabetic neuropathy, trigeminal neuralgia, spinal cord injury) without regard for the presumed mechanism(s) underlying the specific symptoms. A combined etiologic/mechanistic classification might improve neuropathic pain management. The treatment of neuropathic pain is largely empirical, often relying heavily on data from small, generally poorly-designed clinical trials or anecdotal evidence. Consequently, diverse treatments are used, including non-invasive drug therapies (antidepressants, antiepileptic drugs and membrane stabilizing drugs), invasive therapies (nerve blocks, ablative surgery), and alternative therapies (e.g., acupuncture). This article reviews the current and historical practices in the diagnosis and treatment of neuropathic pain, and focuses on the USA, Europe and Japan.

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

“…Several ACs are known to stabilize plasma membrane of peripheral nerve fibers by inhibiting ectopic discharges in altered membranes. 4 Carbamazepine (CBZ) has been the most efficacious (beneficial in 70% of patients) and most used AC in the treatment of TN 1 and was the only drug evaluated in large placebo-controlled trials. 1,5 However, the main problem concerning the use of ACs is the tolerance to the drug doses controlling pain, owing to side effects (dizziness, somnolence, and ataxias).…”

“…1,5 However, the main problem concerning the use of ACs is the tolerance to the drug doses controlling pain, owing to side effects (dizziness, somnolence, and ataxias). 4,6 The absence of CBZ efficacy in some patients, cases of intolerance, 7 hypersensitivity, fluid retention, 8 drug interactions, a narrower therapeutic index and a higher degree of adverse side effects than recent drugs like gabapentin (GBP) has led to a progressively increased use of the latter drug in several neuropathic pain syndromes. [9][10][11][12] GBP has been used alone 13 or in association with CBZ or iamotrigine 14 and results in pain reduction in at least 47% of TN patients.…”

“…However, it should be noted that the effectiveness of GBP and other drugs like Surprisingly, although the association of analgesics with different mechanisms of action may putatively result in analgesia potentiation and less adverse side effects, the possibility for associating drug therapies has been explored very little until present. 4 To the best of our knowledge, and excluding the association of different ACs, 14 no treatment associating different drug classes have been described and no multimodal prospective trials have been performed for TN. A potential adjunctive treatment that have not been explored, is the combination of an AC with an analgesic block of TN facial trigger points using a local anesthetic.…”

Obwodowa neuropatia wywołana chemioterapią. Część II. Zapobieganie

“…Ból neuropatyczny jest wyjątkowo trudnym do leczenia zespołem, dlatego warunkiem osiągnięcia zmniejszenia dolegliwości jest m.in. trafna diagnoza i wdrożenie właściwego leczenia [1][2][3].Często przyczyną dolegliwości jest uszkodzenie nerwu jako struktury anatomicznej przez ucisk z zewnątrz (rozrost guza, materiał kostny przy złama-niach patologicznych, w rzadkich przypadkach przerzuty do nerwów). Z punktu widzenia neuropatologii w takim przypadku sekwencja zdarzeń jest dwuetapowa.…”

“…Ból neuropatyczny jest wyjątkowo trudnym do leczenia zespołem, dlatego warunkiem osiągnięcia zmniejszenia dolegliwości jest m.in. trafna diagnoza i wdrożenie właściwego leczenia [1][2][3].…”