Pharmacology and treatment of neuropathic pains.
OBJECTIVE
This review briefly discusses the definition and clinical presentation of neuropathic pain and highlights recent advances in the treatment of neuropathic pain.


RESULTS
Recent publications have confirmed the efficacy of tricyclic antidepressants, gabapentin, pregabalin, opioids, and tramadol for various neuropathic pain conditions. Selective serotonin noradrenaline reuptake inhibitors have been found to reduce pain in painful neuropathy. The new anticonvulsant lacosamide may have some effect in painful polyneuropathy, whereas levetiracetam has failed to relieve postmastectomy and spinal cord injury pain. The role of the old anticonvulsant phenytoin is still unsettled. A recent trial has found an effect of cannabinoids also in peripheral neuropathic pain. Various topical treatments such as topical lidocaine, topically applied capsaicin in high concentrations (8%), and botulinum toxin have recently been shown to have a pain-relieving effect in various peripheral neuropathic pain conditions. Spinal cord and transcranial magnetic stimulation are stimulation therapies with some evidence for efficacy.


CONCLUSIONS
Treating neuropathic pain remains a great challenge, and the treatment has to be individualized to the single patient, taking into account side effects, pain type, comorbidities, and drug interactions.
Jensen
Troels S
TS
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark. tsjensen@ki.au.dk
Madsen
Caspar S
CS
Finnerup
Nanna B
NB
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002186:Cannabinoids / Q000627:therapeutic use; D002908:Chronic Disease / Q000628:therapy; D004359:Drug Therapy, Combination; D004599:Electric Stimulation Therapy; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D055909:Magnetic Field Therapy; D009437:Neuralgia / Q000175:diagnosis / Q000628:therapy*
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents; D002186:Cannabinoids; D018691:Excitatory Amino Acid Antagonists