Emerging Treatments for Neuropathic Pain

Abstract

Neuropathic pain is a series of well-known conditions caused by diseases or lesions to the somatosensory system. Due to the better understanding of the pathophysiology of neuropathic pain, previously unexplored therapies have been used with encouraging results. As such, Acetyl-L-carnitine (ALC), Alpha-lipoic-acid (ALA), cannabinoids, Clonidine, EMA401, Botulinum Toxin type A, and new voltage-gated sodium channel blockers, can be cited. Furthermore, new modalities in neuromodulation such as high-frequency spinal cord stimulation, burst stimulation, dorsal root ganglion stimulation, transcranial direct current stimulation, and many others have been showing exciting results. Besides, changing paradigms may occur with the advent of optogenetics and a better understanding of epigenetic regulation. This article reviews the published literature on the treatment of NP. Despite the interesting results, randomized controlled trials are demanded for the majority of the therapies previously mentioned.

The Impact of Electrical Charge Delivery on Inhibition of Mechanical Hypersensitivity in Nerve-Injured Rats by Sub-Sensory Threshold Spinal Cord Stimulation

“…Answers to these questions will help in the development of new programming strategies to improve clinical efficacy of SCS. Mechanical hypersensitivity is one important manifestation of neuropathic pain and has often been tested for determining the time course of pain inhibitory effect of SCS in previous animal studies . Accordingly, we compared the effects of different patterns of subthreshold SCS on mechanical hypersensitivity in rats after an L5 spinal nerve ligation (SNL) and determined whether pain inhibition by subthreshold SCS is related to the amount of electric charge delivery.…”

Molecular mechanisms of the analgesic action of Wu-tou Decoction on neuropathic pain in mice revealed using microarray and network analysis

“…Various therapeutic methods, such as non-pharmacological approaches (acupuncture and electric stimulation) and drugs (opioid analgesics, anti-convulsants, gabapentin, tricyclic antidepressants and local anesthetics), have been used to treat NP [5] . However, the treatment effectiveness has not been satisfactory, and side effects often occur.…”

“…Estimation of the incidence and prevalence of NP is difficult, owing to the lack of simple diagnostic criteria. Although a growing number of studies identify several candidate targets for NP treatment, including ion channels, G-protein-coupled receptors, and kinases in neurons and glial cells localized along the nociceptive pathways [2,3] , NP is the most difficult type of chronic pain to manage in the pain clinic [4,5] because the transcriptional or translational regulatory mechanisms underlying the expression and functional changes of these candidate targets have not been fully elucidated.…”

Optogenetics: Therapeutic spark in neuropathic pain

“…A single etiology or specific lesion cannot explain this heterogeneous set of conditions. A multidisciplinary approach to treatment is often the most successful, which includes drugs (antidepressant and antiepileptic drugs), anesthetic techniques, and surgical interventions (in patients with refractory NP) [4,5]. Opioids have been considered a good choice for treatment; however, they fail to reduce the pain and are controversial [6].…”