PainAwareness.org

Contents

• Introduction
• Distinguishing Neuropathic Pain
• The Presentation of Neuropathic Pain*
• Exploring the Pathophysiology of Neuropathic Pain*
• Ion Channels*
• Descending Pain Pathways*
• Treating Neuropathic Pain*
• Nonpharmacologic Treatment Options*
• Treating the Underlying Condition*
• First-Line Pharmacological Therapies for Neuropathic Pain*
• Serotonin-Norepinephrine Reuptake Inhibitors*
• The α-2-δ Ligands: Pregabalin and Gabapentin*
• Topical Lidocaine*
• Opioids and Neuropathic Pain*
• Managing Neuropathic Pain in the Clinic: Case Studies*
• Case Study 1*
• Case Study 2*
• Case Study 3*
• Summary*
• References*
• Additional Information*

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Target Audience

This continuing medical education activity has been developed for physicians, nurses,
pharmacists, and other allied healthcare professionals treating neuropathic pain.

Purpose Statement

The purpose of this newsletter is to increase the knowledge of therapeutic management of
neuropathic pain.

Learning Objectives

After completing this activity, participants will be able to:

• Identify the unique mechanisms of neuropathic pain that may guide treatment choices
• Describe nonpharmacological approaches to managing neuropathic pain
• Discuss pharmacological approaches to managing neuropathic pain

Introduction

Chronic neuropathic pain represents a major burden for patients and the
healthcare system and a tremendous challenge for clinicians. Neuropathic
pain is heterogeneous in nature and difficult to treat; traditional analgesics
such as nonsteroidal antiinflammatory agents (NSAIDs) and acetaminophen
are largely ineffective.¹ Indeed, current management strategies fail to produce adequate
pain relief in a large proportion of patients.² Nevertheless, an expanding range of
treatment options is available, and new agents are in various stages of development. This
tutorial describes the evidence-based management of neuropathic pain and outlines our
current understanding of the pathophysiological mechanisms that help to guide the
selection of appropriate therapy.

Distinguishing Neuropathic Pain

Neuropathic pain is associated with a lesion and/or dysfunction within the central or
peripheral nervous system.³ As with other types of pain, there are many potential
causes. Common etiologies include being related to systemic diseases, such as diabetes;
consequences of infectious disease, such as postherpetic neuralgia (PHN); and as a result
of mechanical impingements, such as radicular low-back or neck pain (Table 1).⁴ The
heterogeneity of neuropathic pain is further illustrated by the wide range of medication
classes used for treatment. Indeed, neuropathic pain can be thought of as a diverse
collection of pain syndromes which have in common the presence of an underlying nerve
injury or dysfunction.³

Medications commonly used for nonneuropathic pain such as osteoarthritis, eg,
NSAIDs, are often not effective in treating neuropathic pain. In addition agents which
may be normally used for medical conditions other than pain relief, such as certain antidepressants and anticonvulsants, have demonstrated efficacy in clinical studies.^1,5,6
Despite these data, patients are commonly treated with less successful strategies,
regrettably perpetuating neuropathic pain.^7,8

To access the full version of this Case & Commentary, please register.
Registration is free and allows you access to all content on PainAwareness.org.