Neuropathic pain

Abstract

Neuropathic pain is a heterogenous condition that results from disorders that affect the central or peripheral nervous system. Herpes zoster results from reactivation of the zoster virus, and may result in postherpetic neuralgia, particularly in the elderly. There is no compelling evidence that antiviral therapy administered acutely during a bout of zoster reduces the risk of developing postherpetic neuralgia. The administration of the zoster vaccine may modestly reduce the risk of developing herpes zoster and postherpetic neuralgia, and anticonvulsant therapy is effective in reducing pain in patients who develop postherpetic neuralgia. Pain is a frequent manifestation of central nervous system disorders, and the prevalence of neuropathic pain following stroke is 12%. Pregabalin and tricyclic medications are effective in the treatment of central neuropathic pain. Neuropathic pain is a potential, disabling manifestation of peripheral neuropathy. Diabetes mellitus is a major potential cause of peripheral neuropathy, and neuropathic pain may occur in as many as 26% of patients. Tricyclic antidepressant medications, pregabalin, and gabapentin are effective in reducing diabetic neuropathic pain. Furthermore, combination therapy using gabapentin and nortriptyline reduces diabetic neuropathic pain.