Therapeutic Approaches for Peripheral and Central Neuropathic Pain.

Délia Szok,János Tajti,László Vécsei,Luigi Trojano,Aliz Nyári

doi:10.1155/2019/8685954

Abstract

Neuropathic pain is a chronic secondary pain condition, which is a consequence of peripheral or central nervous (somatosensory) system lesions or diseases. It is a devastating condition, which affects around 7% of the general population. Numerous etiological factors contribute to the development of chronic neuropathic pain. It can originate from the peripheral part of the nervous system such as in the case of trigeminal or postherpetic neuralgia, peripheral nerve injury, painful polyneuropathies, or radiculopathies. Central chronic neuropathic pain can develop as a result of spinal cord or brain injury, stroke, or multiple sclerosis. As first-line pharmacological treatment options, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids are recommended. In trigeminal neuralgia, carbamazepine and oxcarbazepine are the first-choice drugs. In drug-refractory cases, interventional, physical, and psychological therapies are available. This review was structured based on a PubMed search of papers published in the field from 2010 until May 2019.

Highlights

The current definition of neuropathic pain (NP) was released almost one decade ago by the International Association for the Study of Pain (IASP) [1]
The recommendation of Cognitive behavioural therapy (CBT) in painful diabetic polyneuropathy (PDP) and NP associated with cancer or HIV patients was graded as a good practice point (GPP) [101]
The peripheral and central NP conditions have high prevalence and have a deep impact on the quality of life of the patients. Alleviating this devastating pain condition is challenging for healthcare professionals. The novelty of this present review is the integration of the latest IASP classification of chronic pain with the International Classification of Diseases (ICD-11), first in the literature

Summary

Introduction

The current definition of neuropathic pain (NP) was released almost one decade ago by the International Association for the Study of Pain (IASP) [1] Based on this statement, NP is caused by a lesion or disease of the somatosensory (peripheral and/or central) nervous system. Chronic central NP associated with multiple sclerosis line pharmacological treatments exclusively in peripheral NP. Nonpharmacological therapeutic options for drugrefractory NP include the following approaches: interventional therapies (e.g., peripheral nerve blockade, epidural steroid injection, sympathetic nerve/ganglion treatment, intrathecal drug/medication delivery, and peripheral and central neurostimulation), physical therapies (e.g., massage, ultrasound, transcutaneous electrical nerve stimulation (TENS), laser, and mirror therapy exercise training), and psychological therapies (cognitive behavioural therapy (CBT), psychotherapy, and internet-delivered psychological therapies).

Chronic Peripheral NP

Chronic Central NP

Therapeutic Approaches for NP

Conclusion

Findings

Disclosure