Neuropathic Pain: Pathophysiology and Treatment.

Abstract

Mayo Clinic and Foundation, Rochester, Minnesota. martin.david@mayo.eduNeuropathic Pain: Pathophysiology and Treatment. Edited by Per T. Hansson, Howard L. Fields, Raymond G. Hill, Paolo Marchettini. Seattle, International Association for the Study of Pain, 2001. Pages: 277. Price: $79.00.Neuropathic pain refers to a subset of painful conditions in which there is a lesion to the peripheral or central nervous system. These conditions present a challenging problem for clinicians and include such diagnoses as postherpetic neuralgia, diabetic neuropathy, and complex regional pain syndrome (formerly known as reflex sympathetic dystrophy). Despite an enormous amount of studies conducted at the basic science level with animal models, the application of these results to painful human conditions and their treatment has been slow and difficult. Neuropathic Pain: Pathophysiology and Treatment provides an excellent review of the pathophysiology of neuropathic pain, with a specific focus on translating basic science observations to human pain problems and their treatment.Neuropathic Pain: Pathophysiology and Treatment is the 21st volume in the International Association for the Study of Pain series Progress in Pain Research and Management . The text represents the fruits of two symposia held in conjunction with the International Association for the Study of Pain Ninth World Congress in Vienna, Austria, in 1999. More than a book of symposia proceedings, each chapter provides an extensive review of the literature, with an average of 80 references per chapter. Most chapters include a concise summary and conclusions section to help the reader glean a perspective of the subject quickly.The first half of the book reviews our understanding of the mechanisms underlying neuropathic pain, with specific chapters on sodium channels, cytokines, peripheral and central sensitization, and descending facilitation mechanisms. The role of the sympathetic nervous system is explained thoroughly, with particular attention to reviewing the interplay between animal and human models of neuropathic pain.The second half of the book is devoted to a review of various therapies for neuropathic pain. Chapters discuss pharmacologic choices, including antidepressants, anticonvulsants, opiates, and local anesthetics. A pearl in the book is the evidence-based medicine review of drug efficacy, including a summary of the “Numbers Needed to Treat” for a variety of pharmacologic agents. Some interventional techniques are discussed, including spinal cord and brain stimulation. However, there is little discussion of neuroablative or surgical techniques for neuropathic pain.Any investigator in the field of pain and nociception will find this a useful review and reference. Clinicians practicing pain medicine will appreciate this volume for its succinct review of current basic science mechanisms that may underlie the signs and symptoms encountered in patients with neuropathic pain on a daily basis. The area of neuropathic pain is challenging, and more questions are raised than are answered. Neuropathic Pain: Pathophysiology and Treatment should serve as a catalyst for the ongoing dialogue between clinicians and scientists in their common pursuit to help patients suffering from neuropathic pain.