Neuropathic Pain: The Global Challenge

Abstract

Neuropathic pain conditions cause suffering and disability in many millions of our global citizenry. Nutritional deficiency syndromes, environmental toxicities, AIDS, and other infectious scourges dominate the prevalence pattern of neuropathic pain in many economically challenged parts of the world. More developed parts of the world face a different spectrum of neuropathic pain disorders. In these countries, better prevention and control of many formerly fatal diseases in middle age (e.g., gastrointestinal and pulmonary infections, tuberculosis, heart disease, and certain cancers) create aging populations that accrue risk for chronic conditions associated with neuropathic pain, such as diabetes and cancer. Ironically, in the case of can-cer, even when biomedical treatment successfully remits or cures the disease, these same treatments, such as surgery, chemotherapy, and radiation, often damage nervous tissue, causing chronic neuropathic pain. Hence, the thrill of cure may be obliterated by the enduring agony of a life preserved in chronic pain. Fortunately, the growing incidence of neuropathic pain is concomitant with an explosion of knowledge about the neurophysiology of pain, the phenomenology and pathophysiology of neuropathic pain as a disease, and the mechanisms underlying the effectiveness of a rapidly growing armamentarium of pharmacologic and nonpharmacologic treatments for …