Neuropathic pain: a practical guide for the clinician

Neuropathic pain, caused by various central and peripheral nerve disorders, is especially problematic because it can be severe, chronic, and resistant to analgesics. Neuropathic pain affects 2%-3% of the population, is costly to the healthcare system and can be devastating to patients. The diagnosis is based primarily on the patient’s medical history (e.g., underlying disorder and pain characteristics) and the physical examination. Treatments are generally palliative and include some nonpharmacologic therapies, pharmacologic therapy, and invasive interventions, such as spinal cord stimulation. Personalizing treatment requires consideration of the functional impact of the neuropathic pain (e.g., depression, disability), ongoing evaluation, patient education, reassurance, and referral to a specialist.

The researchers suggest an algorithm for the more effective treatments, which include topical lidocaine, gabapentin, pregabalin, tricyclic antidepressants, mixed serotonin-norepinephrine reuptake inhibitors, tramadol, and opioids. Neuropathic pain research and treatment are in their early stages. In the future, several advancements are expected. These may provide new and improved therapies for patients. Gilron I; Watson C; Cahill C; Moulin D. Adapted from Canadian Medical Association Journal. 2006 Aug 1;175(3).

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