Diagnosis and treatment of neuropathic pain.
OBJECTIVE
Neuropathic pain accounts for 25-50% of pain clinic visits with an estimated prevalence of 4 million. Neuropathic pain is often difficult to diagnose and treat with few pharmacologic options currently available. This review summarizes the latest research on the pathophysiology, diagnosis and treatment of neuropathic pain.


RESULTS
The diagnosis of neuropathic pain relies on an evaluation of information given by the patient and physical findings obtained by the health provider. There are several validated questionnaires that can be used. Neuropathic pain is associated with a number of different cellular and molecular mechanisms. These include abnormalities in ion channels; exaggerated responses to cytokines, enzymes and neuropeptides; and abnormal communications between large/small fibers and sympathetic/small fibers. An understanding of these mechanisms has led to mechanistic directed treatments including topical treatments, antiepileptics, antidepressants, opioids and other drugs in development that are more mechanistically driven.


CONCLUSIONS
Neuropathic pain is common, underdiagnosed and undertreated. Diagnosing and understanding the basic mechanisms of neuropathic pain will lead to better treatments of this difficult health care problem.
Wallace
Mark S
MS
Department of Clinical Anesthesiology, University of California, San Diego, La Jolla, California 92037, USA. mswallace@ucsd.edu