Reducing and eliminating neuropathic pain

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P R Health Sci J. 2009 Dec;28(4):289-300.

Reducing and eliminating neuropathic pain.

Santiago-Figueroa J, Kuffler DP.

Department of Orthopedic Surgery, Medical Sciences Campus, University of Puerto

Rico, San , Puerto Rico.

Neuropathic pain is initiated or caused by a primary lesion or dysfunction in

the central and/or peripheral nervous systems, including infection, trauma,

metabolic abnormalities, and nerve compression, and is typically accompanied by

hyperalgesia and allodynia. Neuropathic pain can be mild to excruciating,

debilitating, difficult to manage, cause depression, decrease the quality of

life, require extremity amputations, and has a variety of clinical symptoms.

It effects up to 5% of the population, 70% of patients with advanced cancer and

inflammatory pathologies, and 95% of patients with spinal cord injuries. The

primary treatments of neuropathic pain are antidepressants, anticonvulsants,

local anesthetic/topical agents, and opioids. The rapidly evolving symptom- and

mechanism-based approaches to the treatment of neuropathic pain holds promise

for improving the quality of life of patients with neuropathic pain.

However, pharmacological treatment of the symptoms are difficult because of the

limited understanding of the underlying causes of the pain, and the systemic

levels of multiple side effects induced by various agents at an effective dose.

Further, neuropathic pain is often refractory to conventional analgesic

treatments, with most patients obtaining only partial relief with these agents,

and with tolerability or side effects often limiting their use. A

lternative treatments to pharmacology include peripheral or neuraxial nerve

blockade, and implanted cortical or spinal cord stimulators. However, the great

need remains for development of new and more effective approaches to reducing

neuropathic pain. This review examines various approaches currently used for

treatment of neuropathic pain and potential new and more effective approaches.