Neuropathic pain: a pathway for care developed by the British Pain Society

Abstract

Neuropathic pain is a common chronic pain condition that can be challenging to treat, particularly for non-specialists. The development of the Map of Medicine care pathway for the management of neuropathic pain was led by the British Pain Society. Focusing on treatment by non-specialists, this pathway is based on new evidence, consensus, and the interests of service users. This paper presents the care pathway and accompanying evidence base, highlighting its salient features, and discussing important treatment points. After initial assessment, the pathway progresses through first-, second-, and third-line drug treatment, includes advice on topical treatment and opioids (in specific circumstances), and describes non-pharmacological approaches. Importantly, timely review of patients and referral to specialist secondary or tertiary care must be considered as vital components of the pathway. Although the emphasis was not on specialist treatment, advice is given on existing interventions, including neural stimulation and multi-disciplinary care. These, and other steps on the pathway, will be subject to further review as more evidence becomes available. In the meantime, the pathway represents a straightforward, valuable and accessible approach for healthcare professionals managing the distress and impact of neuropathic pain.

National survey of pain clinics in Croatia: Organization and services

“…There are several international manuscripts about the organization and delivery of pain services that could be used as a guidance for improving pain management (28)(29)(30)(31)(32). Educational activities in most pain clinics in Croatia focus on providing educational materials for patients developed by pharmaceutical companies, and less frequently on educational materials developed by the Croatian Association for the Treatment of Pain or employees of the clinics.…”

The clinical approach to small fibre neuropathy and painful channelopathy

“…Recently, consensus guidelines for neuropathic pain have been adapted for treatment of pain in SFN 2. Pragmatic consensus guidelines include those of the UK's National Institute of Health and Care Excellence and the Map of Medicine 56. This usually involves first-line treatment with gabapentinoids, gabapentin or pregabalin (that bind to α 2 δ 1 and alter trafficking of voltage-gated calcium channels), tricyclic antidepressant (unlicensed indication) or serotonin-norepinephrine reuptake inhibitor (licensed for painful diabetic neuropathy).…”

Inhaled hydrogen sulfide prevents neuropathic pain after peripheral nerve injury in mice

“…The estimate of the annual cost of chronic pain was greater than the annual costs of heart disease ($309 billion), cancer ($243 billion), and diabetes ($188 billion) [2]. Neuropathic pain is a common chronic pain condition [3] that is caused by peripheral nerve injury and is characterized by long-lasting exaggerated pain behavior such as allodynia and hyperalgesia [4]. Although neuropathic pain is known as a particularly unpleasant type of pain [3], the management of patients with neuropathic pain is challenging because of the multiplicity of mechanisms involved in neuropathic pain conditions [5].…”

“…Neuropathic pain is a common chronic pain condition [3] that is caused by peripheral nerve injury and is characterized by long-lasting exaggerated pain behavior such as allodynia and hyperalgesia [4]. Although neuropathic pain is known as a particularly unpleasant type of pain [3], the management of patients with neuropathic pain is challenging because of the multiplicity of mechanisms involved in neuropathic pain conditions [5]. Precise pathophysiological mechanisms of neuropathic pain are still unclear, however, a number of studies have suggested that microglial activation and inflammatory cytokines in the spinal cord play important roles in the development and maintenance of neuropathic pain [6,7].…”