Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations.
Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism-based approach.
Dworkin
Robert H
RH
Department of Anesthesiology, University of Rochester School of Meedicine and Dentistry, Rochester, NY 14642. robert_dworkin@urmc.rochester.edu
Backonja
Miroslav
M
Rowbotham
Michael C
MC
Allen
Robert R
RR
Argoff
Charles R
CR
Bennett
Gary J
GJ
Bushnell
M Catherine
MC
Farrar
John T
JT
Galer
Bradley S
BS
Haythornthwaite
Jennifer A
JA
Hewitt
David J
DJ
Loeser
John D
JD
Max
Mitchell B
MB
Saltarelli
Mario
M
Schmader
Kenneth E
KE
Stein
Christoph
C
Thompson
David
D
Turk
Dennis C
DC
Wallace
Mark S
MS
Watkins
Linda R
LR
Weinstein
Sharon M
SM
D000700:Analgesics / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D009437:Neuralgia; D010808:Physical Examination
D000700:Analgesics