What is new in neuropathic pain?
BACKGROUND
Neuropathic pain occurs in 1% of the population and is difficult to manage. Responses to single drugs are limited in benefit. Thirty percent will fail to respond altogether. This is a review of newer drugs and treatment paradigms.


METHODS
A literature review was performed pertinent to new drugs and treatment algorithms in the management of neuropathic pain.


RESULTS
New information on opioids (tramadol and buprenorphine) suggests benefits in the management of neuropathic pain and has increased interest in their use earlier in the course of illness. Newer antidepressants, selective noradrenaline, and serotonin reuptake inhibitors (SNRIs) have evidence for benefit and reduced toxicity without an economic disadvantage compared to tricyclic antidepressants (TCAs). Pregabalin and gabapentin are effective in diabetic neuropathy and postherpetic neuralgia. Treatment paradigms are shifting from sequential single drug trials to multiple drug therapies. Evidence is needed to justify this change in treatment approach.


CONCLUSIONS
Drug choices are now based not only on efficacy but also toxicity and drug interactions. For this reason, SNRIs and gabapentin/pregabalin have become popular though efficacy is not better than TCAs. Multiple drug therapies becoming an emergent treatment paradigm research in multiple drug therapy are needed.
Davis
Mellar P
MP
The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Health System, 9500 Euclid Avenue, R35, Cleveland, OH 44195, USA. davism6@ccf.org
D002047:Buprenorphine / Q000494:pharmacology; D004359:Drug Therapy, Combination; D006801:Humans; D009294:Narcotics / Q000494:pharmacology*; D009437:Neuralgia / Q000188:drug therapy / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*; D014147:Tramadol / Q000494:pharmacology
D002047:Buprenorphine; D009294:Narcotics; D017367:Selective Serotonin Reuptake Inhibitors; D014147:Tramadol