Pharmacological treatment of neuropathic pain

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Drugs Today (Barc). 2009 Nov;45(Supl. C):7-12.

Pharmacological treatment of neuropathic pain

Yeng LT.

Hospital das Clinicas da Faculdade de Medicina da USP, Instituto de Ortopedia e

Traumatologia.

Neuropathic pain (NP), in view of its non-nociceptive component, is not caused

by physiological lesions but by problems in the nervous system itself, whether

in the central nervous system (CNS) or peripheral nervous system (PNS). This

particular action mechanism makes NP a very difficult-to-treat condition,

resistant to most of the commonly used analgesic drugs.

A recent study stated that NP has an incidence of 1.24% over the general

population, and this percentage increases if we consider acute radiculopathies

and some recurrent neuropathies, frequently considered not only neuropathic pain

but also nociceptive. Thus, the improvement of NP treatment has become a public

health necessity.

While WHO recommendations include a three-lined scale in pain treatment

-including NSAIDs as the first-line drugs, soft opioids (tramadol or codein) as

the second-line, and strong opioids (morphine, oxycodone, and phentanyl) as the

third-line- some studies have found this rationale not useful in NP treatment.

Based on several studies as STEP, Spanish Pain Society recommendations included

antidepressant and anticonvulsant drugs as the first line treatment. Pregabalin,

a new neuromodulators class drug, provides a pharmacokinetic profile than its

predecessors (phenytoin, carbamazepine, gabapentin, topiramate, oxcarbazepine,

and lamotrigine), and showed effectiveness controlling peripheral neuropathic

pain. Thus, pregabalin opened the door to a new approach to NP.

Other pain societies, such as the Canada Pain Society, have also included

pregabalin in the first line treatment of NP. In fact, gabapentin and pregabalin

are the current standard care in most of NP-associated diseases.