Contemporary management of neuropathic pain for the primary care physician.
Neuropathic pain (NP), caused by a primary lesion or dysfunction in the nervous system, affects approximately 4 million people in the United States each year. It is associated with many diseases, including diabetic peripheral neuropathy, postherpetic neuralgia, human immunodeficiency virus-related disorders, and chronic radiculopathy. Major pathophysiological mechanisms include peripheral sensitization, sympathetic activation, disinhibition, and central sensitization. Unlike most acute pain conditions, NP is extremely difficult to treat successfully with conventional analgesics. This article introduces a contemporary management approach, that is, one that incorporates nonpharmacological, pharmacological, and interventional strategies. Some nonpharmacological management strategies include patient education, physical rehabilitation, psychological techniques, and complementary medicine. Pharmacological strategies include the use of first-line agents that have been supported by randomized controlled trials. Finally, referral to a pain specialist may be indicated for additional assessment, interventional techniques, and rehabilitation. Integrating a comprehensive approach to NP gives the primary care physician and patient the greatest chance for success.
Chen
Hsiupei
H
Division of Pain Medicine, Duke University Medical Center, Durham, NC, USA. chen0025@mc.duke.edu
Lamer
Tim J
TJ
Rho
Richard H
RH
Marshall
Kenneth A
KA
Sitzman
B Todd
BT
Ghazi
Salim M
SM
Brewer
Randall P
RP
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D000529:Complementary Therapies / Q000379:methods; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000175:diagnosis / Q000628:therapy; D010147:Pain Measurement; D010148:Intractable Pain / Q000175:diagnosis / Q000628:therapy*; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000628:therapy*; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents