The treatment of neuropathic pain.
Neuropathic pain is responsible for a significant amount of the morbidity associated with generalized and focal peripheral neuropathies. It is a consequence of alterations in neuronal function, chemistry, and structure that occur secondary to nerve injury. These manifestations of neuronal plasticity occur in the peripheral nerve, spinal cord, and brain. A variety of agents from diverse pharmacologic classes, the so-called adjuvant analgesics, have been used to treat neuropathic pain. These include antidepressants, first- and second-generation anticonvulsants, antiarrhythmic agents, topical agents, N-methyl-D-aspartate receptor antagonists, and opioid analgesics. The use of these adjuvant analgesics, either alone or in combination, should result in the alleviation of neuropathic pain in most patients. Recent advances in the understanding of pain mechanisms at multiple central nervous system levels should pave the way toward more effective treatment modalities.
Freeman
Roy
R
Department of Neurology, Harvard Medical School, Boston, MA 02215, USA. rfreeman@bidmc.harvard.edu
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002211:Capsaicin / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D051474:Neuralgia, Postherpetic / Q000188:drug therapy* / Q000503:physiopathology; D009619:Nociceptors / Q000502:physiology; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D015222:Sodium Channels / Q000502:physiology
D000889:Anti-Arrhythmia Agents; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D002211:Capsaicin; D017367:Selective Serotonin Reuptake Inhibitors; D015222:Sodium Channels