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Feature Article

Treatment of neuropathic pain

Robert Helme

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Abstract

Neuropathic pain is under-recognised and therefore undertreated. Most patients require a meticulous history and detailed examination so that a cause can be sought. Treatment is relatively straightforward and includes regular analgesics and adjuvant agents.

Key Points

  • Neuropathic pain has recently been defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.
  • Neuropathic pain is under-recognised and therefore undertreated.
  • Most forms of neuropathic pain are due to sensitisation of neurons in the central pathways. This sensitisation is normally associated with the transmission of noxious stimuli.
  • Treatment is largely empirical with no clear evidence for selective benefits of medications on spontaneous and stimulus-evoked pain.
  • The main treatments of neuropathic pain are adjuvant analgesics, mainly those from antidepressant and antiepileptic drug classes. Regular opioid analgesics also result in improvement in some patients.
  • Outcomes are often unsatisfactory in patients with severe persistent pain. These patients may benefit from specialist referral.

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