Reducing and eliminating neuropathic pain.
Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the central and/or peripheral nervous systems, including infection, trauma, metabolic abnormalities, and nerve compression, and is typically accompanied by hyperalgesia and allodynia. Neuropathic pain can be mild to excruciating, debilitating, difficult to manage, cause depression, decrease the quality of life, require extremity amputations, and has a variety of clinical symptoms. It effects up to 5% of the population, 70% of patients with advanced cancer and inflammatory pathologies, and 95% of patients with spinal cord injuries. The primary treatments of neuropathic pain are antidepressants, anticonvulsants, local anesthetic/topical agents, and opioids. The rapidly evolving symptom- and mechanism-based approaches to the treatment of neuropathic pain holds promise for improving the quality of life of patients with neuropathic pain. However, pharmacological treatment of the symptoms are difficult because of the limited understanding of the underlying causes of the pain, and the systemic levels of multiple side effects induced by various agents at an effective dose. Further, neuropathic pain is often refractory to conventional analgesic treatments, with most patients obtaining only partial relief with these agents, and with tolerability or side effects often limiting their use. Alternative treatments to pharmacology include peripheral or neuraxial nerve blockade, and implanted cortical or spinal cord stimulators. However, the great need remains for development of new and more effective approaches to reducing neuropathic pain. This review examines various approaches currently used for treatment of neuropathic pain and potential new and more effective approaches.
Santiago-Figueroa
José
J
Department of Orthopedic Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Kuffler
Damien P
DP
D002908:Chronic Disease; D006801:Humans; D009422:Nervous System Diseases / Q000150:complications*; D009437:Neuralgia / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*