Pharmacotherapy of neuropathic pain

Abstract

Pathophysiologically, neuropathic pain (NPP) is one of the types of pain. It can occur alone or together with nociceptive pain, as mixed pain, in tumorous disease as well as for non-tumorous reasons. It is caused by a dysfunction of or damage to neural tissue at various sites, ranging from the periphery to central structures. Neuropathic pain has a typical clinical presentation which is very diverse. An underlying anatomic basis is not invariably found. One neuropathic syndrome may present with different symptoms. The treatment of NPP is difficult and not always successful. Pharmacotherapy is the mainstay of treatment that may help achieve an acceptable intensity of the pain. Anticonvulsants and tricyclic antidepressants (amitriptyline) are the first choice with opioids being the second. Some neuropathic pain syndromes are so difficult to manage that invasive procedures have to be used, such as spinal blockage, sympathetic or peripheral plexus blockage, and modern neuromodulation and radiofrequency techniques. Local treatment with lidocaine or capsaicin can be used as adjunct therapy for NPP; local NSAIDs are minimally effective.