Pharmacology and treatment of neuropathic pains

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Curr Opin Neurol. 2009 Sep 8.

Pharmacology and treatment of neuropathic pains.

Jensen TS, Madsen CS, Finnerup NB.

Department of Neurology and Danish Pain Research Center, Aarhus University

Hospital, Aarhus, Denmark.

PURPOSE OF REVIEW: This review briefly discusses the definition and clinical

presentation of neuropathic pain and highlights recent advances in the treatment

of neuropathic pain.

RECENT FINDINGS: Recent publications have confirmed the efficacy of tricyclic

antidepressants, gabapentin, pregabalin, opioids, and tramadol for various

neuropathic pain conditions. Selective serotonin noradrenaline reuptake

inhibitors have been found to reduce pain in painful neuropathy. The new

anticonvulsant lacosamide may have some effect in painful polyneuropathy,

whereas levetiracetam has failed to relieve postmastectomy and spinal cord

injury pain.

The role of the old anticonvulsant phenytoin is still unsettled. A recent trial

has found an effect of cannabinoids also in peripheral neuropathic pain. Various

topical treatments such as topical lidocaine, topically applied capsaicin in

high concentrations (8%), and botulinum toxin have recently been shown to have a

pain-relieving effect in various peripheral neuropathic pain conditions.

Spinal cord and transcranial magnetic stimulation are stimulation therapies with

some evidence for efficacy.

SUMMARY: Treating neuropathic pain remains a great challenge, and the treatment

has to be individualized to the single patient, taking into account side

effects, pain type, comorbidities, and drug interactions.