Challenges in the treatment of neuropathic pain

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Drugs Today (Barc). 2009 Nov;45(Supl. C):1-5.

Challenges in the treatment of neuropathic pain.

Teixeira MJ.

Diretor Tecnico de Servico de Saude do Servico de Neurocirurgia da Divisao de

Clinica Neurocirurgica das Unidades Medicas e de Apoio do Instituto Central do

Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao o.

Professor Titular da Disciplina de Neurocirurgia da Faculdade de Medicina da

Universidade de Sao o.

Neuropathic pain is a difficult to diagnose condition. The definition changes

have tried to clarify the confusing consequences about including the word

" dysfunction " . However, diagnosing problems are not only a definition issue, but

also a technical problem. Heat-pulsing-lasers are a very interesting tool to

diagnose neuropathic pain, but, at the moment, they are not available in many

clinical centers. Because there was not a precise diagnostic tool widely

available, a gradation system was developed.

It classifies neuropathic pain into three categories: definite, probable or

possible neuropathic pain. Neuropathic pain can be produced by different lesions

or diseases, either in the central nervous system (CNS) or in the peripheral

nervous system (PNS), and it uses to appear in a context of some comorbidities,

so it is important to determine the impact over the quality of life and also

over the economy (chronic treatment and sick leaves).

Some studies have tried to estimate these consequences. Pregabalin has provided

throughout different studies important health system cost reductions and also

reduced sick leaves. Nevertheless, because only pharmacological-based therapies

cannot control disease symptoms and there are still diagnostic problems, it is

important to perform a multidisciplinary approach to neuropathic pain to balance

these issues.

Thus, some studies have investigated different non-pharmacological approaches to

treat neuropathic pain, such as intensive exercise, hydrotherapy, transcutaneous

electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation,

motor imagery programs (MIP), supportive psychotherapy, and cognitive behavior

therapy. To perform these non-pharmacological therapies, a multidisciplinary

team focused on individualizing pain management is needed.