Neuropathic Pain Management, Pharmacological Approaches, Neuromodulation and Quality of Life

Abstract

Neuropathic pain, which affects 7%–10% of the general population, is caused by a lesion or disease of the somatosensory system, which includes peripheral fibers and central neurons. There are numerous known causes of neuropathic pain, and as the world's population ages, the prevalence of diabetes mellitus rises, and cancer patients are more likely to survive postchemotherapy. Its occurrence is projected to rise. The intricacy of neuropathic symptoms, adverse outcomes, and challenging treatment choices all appear to contribute to the burden of chronic neuropathic pain. Crucially, neuropathic pain patients have a lower quality of life due to a higher need for prescription drugs, more frequent visits to the physician, the morbidity from the pain itself, and the underlying disease. The most effective strategy to treat neuropathic pain would employ the right combination of pharmacological and nonpharmacologic therapy. As first-line treatments, gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are advised while tramadol and opioids are regarded as second-line therapy. Because there are currently insufficient high-quality trials, cannabinoids are advised as third-line treatments, and methadone and some anticonvulsants are suggested as fourth-line therapies. In cases of failure of pharmacological therapy or other special considerations, neuromodulation therapy is suggested, which involves deep brain stimulation, spinal cord stimulation, transcranial magnetic stimulation, and transcranial current stimulation and is broadly categorized under invasive and non-invasive neuromodulation procedures. In this study, we aim to comprehensively review the existing management strategies for neuropathic pain, specifically in the context of pharmacological, neuromodulation, and quality of life domains.