Neuropathic pain - current concepts

Abstract

Neuropathic pain (NP) represents a common and diverse group of disorders with peripheral and/or central nervous system damage or dysfunction. Many patients report intractable and severe pain that is resistant to simple analgesics. The diagnosis of NP is primarily based on clinical evaluation rather than diagnostic tests. Distinct pain qualities in the patient’s history and findings on clinical examination, such as hyperalgesia and other sensory findings in an area correlating with the patient’s pain pattern are important in diagnosis. Various screening tools may assist in the diagnosis of NP. A number of pathophysiological mechanisms have been identified in NP, including sodium- and calcium-channel upregulation and spinal cord hyperexcitability (central sensitisation).Appropriate management includes evaluation of the functional impact of NP, patient education and reassurance. A multi-model biopsychosocial approach that includes various nonpharmacological modalities is recommended. Appropriate pharmacological management is based on evidence-based recommendations that provide guidance for selecting first-, second- and third-line medications, alone or in combination. It is hoped that future treatment advances will improve the care of patients who live with NP.