Neuropathic pain: treatment

Yi Pan MD PhD (Dr. Pan of St. Louis University has no relevant financial relationships to disclose.)
Florian P Thomas MD MA PhD MS (Dr. Thomas, Chair, Department of Neurology, Seton Hall-Hackensack-Meridian School of Medicine, has no relevant financial relationships to disclose.)
Louis H Weimer MD, editor. (Dr. Weimer of Columbia University has received consulting fees from Roche.)
Originally released August 31, 2001; last updated July 6, 2017; expires July 6, 2020

Overview

Treatment of neuropathic pain is an ongoing challenge for clinicians. In this article, the authors summarize pharmacological management based on published clinical trials. Not all medications mentioned in this article have been investigated in placebo-controlled, double-blind, randomized trials. The aim of this article is to provide a variety of updated information so clinicians can choose an optimal treatment for an individual patient.

Key points

 

• Neuropathic pain is frequently treated with antidepressants, anticonvulsants, antiarrhythmics, topical agents, and analgesics.

 

• The treatment must be individualized.

 

• Combination of different agents should be considered in some patients.

 

• Slow dose escalation may improve drug tolerability.

Historical note and terminology

Neuropathic pain results from injury to the central or peripheral nerve systems and is characterized by a neuronal hyperexcitability. Treatment of painful neuropathies has been a challenge to clinicians. Definitive clinical trials to evaluate the efficacy of pharmacological agents or other therapies require careful randomization of subjects representative of the relevant population, appropriate sample sizes, and an adequate number of reliable measurement scales. One of the challenges stems from the fact that placebo treatments are effective in a significant number of patients (Petersen et al 2012). Treatment of central pain following stroke or spinal cord injury is similar to the treatment of painful neuropathy. This article will focus on painful neuropathy.

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