Diagnosis and management of neuropathic pain: a balanced approach to treatment.
OBJECTIVE
To provide nurse practitioners with a conceptual framework from which to diagnose and manage chronic neuropathic pain, specifically postherpetic neuralgia (PHN). A current review of the available treatment options for the management of neuropathic pain and PHN is provided.


METHODS
A comprehensive literature review was conducted. Clinical articles, meta-analyses, and reviews were selected for their relevance to the diagnosis and management of chronic neuropathic pain and PHN.


CONCLUSIONS
Managing patients with chronic neuropathic pain is a common clinical challenge due to variability in individual symptoms, mechanisms, and treatment responses. In patients with PHN, a balanced treatment approach focusing on efficacy, safety, and tolerability is recommended. With appropriate treatment, most patients are able to achieve clinically significant relief from neuropathic pain.


CONCLUSIONS
Diagnosis and management of neuropathic pain syndromes is challenging. Because of the complexity of chronic pain, successful long-term treatment can be especially difficult (Nicholson, 2003b). While most acute pain is nociceptive (i.e., a response to noxious stimuli), chronic pain can be nociceptive, neuropathic, or of mixed origin. PHN is a chronic pain syndrome that can last for years, causing physical and social disability and psychological distress (Kanazi, 2000). Despite major recent advances in the treatment of PHN, many patients remain refractory to current therapy (Dworkin, 2003). For practicing clinicians, including nurse practitioners, viewing pain as a disease rather than a symptom is the first step towards its successful management. Understanding the pathophysiology of chronic pain and emerging treatment paradigms for the management of neuropathic pain and PHN is critical to optimal care.
Nicholson
Bruce D
BD
Division of Pain Medicine and Hospice, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania, USA.
D000085:Acetates / Q000627:therapeutic use; D000588:Amines; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003509:Cyclohexanecarboxylic Acids; D000077206:Gabapentin; D006562:Herpes Zoster / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009437:Neuralgia / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D009722:Nurse Practitioners; D010147:Pain Measurement; D015995:Prevalence; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000928:Antidepressive Agents; D003509:Cyclohexanecarboxylic Acids; D009294:Narcotics; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D008012:Lidocaine