Treatment selection for neuropathic pain depends as much on comorbid sleep disturbance, depression, anxiety and particularly in the elderly, medical comorbidities as on the pain itself.
Most neuropathic pain in the community goes unrecognised and untreated. Even when patients and their general practitioners recognise neuropathic pain – defined as ‘pain arising as a direct consequence of a lesion or disease affecting the somatosensory system’ – they often adopt a nihilistic attitude to treatment. Many of the medications commonly used for nociceptive pain (pain caused by tissue damage or potentially tissue-damaging stimuli) are not effective in neuropathic pain. Likewise, many physical approaches for managing nociceptive pain may not be appropriate for neuropathic pain. Research into treatments for neuropathic pain has, however, expanded rapidly in the past decade, and there is growing consensus about management of this type of pain.