Contemporary management of neuropathic pain for the primary care physician

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Abstract from Mayo Clin Proc. 2004 Dec;79(12):1533-45.

Contemporary management of neuropathic pain for the primary care physician.

Chen H, Lamer TJ, Rho RH, Marshall KA, Sitzman BT, Ghazi SM, Brewer RP.

Division of Pain Medicine, Duke University Medical Center, Durham, NC, USA.

Neuropathic pain (NP), caused by a primary lesion or dysfunction in the nervous

system, affects approximately 4 million people in the United States each year.

It is associated with many diseases, including diabetic peripheral neuropathy,

postherpetic neuralgia, human immunodeficiency virus-related disorders, and

chronic radiculopathy. Major pathophysiological mechanisms include peripheral

sensitization, sympathetic activation, disinhibition, and central sensitization.

Unlike most acute pain conditions, NP is extremely difficult to treat

successfully with conventional analgesics. This article introduces a

contemporary management approach, that is, one that incorporates

nonpharmacological, pharmacological, and interventional strategies.

Some nonpharmacological management strategies include patient education,

physical rehabilitation, psychological techniques, and complementary medicine.

Pharmacological strategies include the use of first-line agents that have been

supported by randomized controlled trials. Finally, referral to a pain

specialist may be indicated for additional assessment, interventional

techniques, and rehabilitation. Integrating a comprehensive approach to NP gives

the primary care physician and patient the greatest chance for success.