Evaluation and treatment of painful peripheral polyneuropathy

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Semin Neurol. 2005 Jun;25(2):185-95.

Evaluation and treatment of painful peripheral polyneuropathy.

Singleton JR.

Department of Neurology, University of Utah, Salt Lake City, Utah.

Pain is a common component of sensory peripheral polyneuropathy and

occurs primarily as a consequence of injury to small, unmyelinated C-

fiber nerve axons. This class of fibers is particularly vulnerable to

metabolic injury, and the neuropathy manifests in a length-dependent

pattern. Diabetes mellitus, prediabetes associated with insulin

resistance, toxins, and drugs are common causes of painful

neuropathy, but a substantial percentage are idiopathic. Pathogenesis

of neuropathic pain involves loss of peripheral axons and

inappropriate peripheral and central adaptation of neuronal signaling

to this loss. Treatment of painful neuropathy should be directed at

removing the offending metabolic injury, if possible. Antiepileptic

drugs, tricyclic antidepressants, opiates, and other treatments have

shown efficacy in clinical trials for symptomatic relief of

neuropathic pain.