Treatment of neuropathic pain: An update

Abstract

Neuropathic pain concerns 5–7% of the general population and its treatment is unsatisfactory. Drug therapy recommended as first or second line include antidepressants (tricyclic agents, serotonin–norepinephrine reuptake inhibitors such as duloxetine), gabapentinoids (pregabalin, gabapentin and newer gabapentin formulations), topical agents for peripheral neuropathic pain (lidocaine plasters, capsaicin high concentration patches) and tramadol, while strong opioids and botulinum toxin A (for peripheral neuropathic pain) may be proposed as last choice. However the efficacy of these treatments is generally incomplete and limited ; therefore an individualized therapeutic approach is considered as the most rationale therapeutic approach. Compounds acting on new targets such as newer sodium channel antagonists are in development. Noninvasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) are increasingly proposed. Psychological management is often required. More refractory cases may necessitate invasive therapy, particularly spinal cord stimulation. [1]Colloca L. Ludman T. Bouhassira D. Baron R. Dickenson A.H. Yarnitsky D. Freeman R. Truini A. Attal N. Finnerup N.B. Eccleston C. Kalso E. Bennett D.L. Dworkin R.H. Raja S.N. Neuropathic pain.Nat Rev Dis Primers. 2017 Feb 16; 317002Google Scholar; [2]Finnerup N. Attal N. Haroutounian S. et al.Pharmacotherapy for neuropathic pain in adults: systematic review, meta-analysis and NeuPSIG recommendations.Lancet Neurol. 2015; 14: 162-173Google Scholar