Novel pharmacologic options in the treatment of neuropathic pain

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Abstract from CNS Spectr. 2004 Oct;9(10 Suppl 10):1-11.

Novel pharmacologic options in the treatment of neuropathic pain.

Irving G, Goli V, Dunteman E.

Department of Anesthesia, University of Washington Medical School,

Seattle, WA, USA.

Neuropathic pain is highly prevalent in the United States, occurring in

up to 4 million people. Many changes affecting the ascending

facilitatory system and the descending inhibitory system occur within

the central nervous system as a result of neuropathy, making successful

treatment difficult. The physiological changes are more complicated in

humans than in animals, and medications which have been shown to be

successful in animal models are often determined to be failures in phase

II or III studies in humans. The concepts of peripheral and central

sensitization help to elucidate the pathophysiology of neuropathic pain,

and functional magnetic resonance imaging (fMRI) shows promise in

further informing us about the brain's processing of different pains.

Neuropathic pain is commonly treated with anticonvulsant medications.

There are several potential new treatments being evaluated for

neuropathic pain, including N-methyl-D-aspartate antagonists,

cannabinoids, immunomodulatory medications, and some antidepressants.

Given the complexity of neuropathic pain, a multidisciplinary approach

to treatment is preferable to pharmacologic treatment alone. Treatment

goals should target improving pain and physical function, and reducing

psychological stress. This involves use of behavioral treatments such as

cognitive-behavioral therapy, operant conditioning, and biofeedback;

alternative therapies such as hypnosis and acupuncture; and in some

patients, controversial treatments such as opioids and herbal medicines,

in addition to standard pharmacologic treatment.