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      A review of Neuropathic Pain: From Guidelines to Clinical Practice

      review-article
      Author(s): ,
      Publication date (Electronic):
      Journal: Pain and Therapy
      Publisher: Springer Healthcare
      Keywords: Analgesia, Diagnosis, Guidelines, Neuropathic pain, Quality of life, Treatment

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          Abstract

          Neuropathic pain is a chronic condition representing a significant burden for patients, society, and healthcare systems. The prevalence of neuropathic pain in the general population has been estimated at 7–8% and is expected to increase in the future. Neuropathic pain differs from nociceptive pain and requires a different therapeutic approach; and the management of neuropathic pain is complicated and challenging. This chapter discusses clinical practice guidelines for neuropathic pain and their usefulness in clinical practice.

          Funding: Pfizer, Italy.

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          Neuropathic pain in the general population: a systematic review of epidemiological studies.

          O van Hecke, Sophie K Austin, Rafi A Khan … (2014)
          Most patients with neuropathic pain symptoms present and are managed in primary care, with only a minority being referred for specialist clinical assessment and diagnoses. Previous reviews have focused mainly on specific neuropathic pain conditions based in specialist settings. This is the first systematic review of epidemiological studies of neuropathic pain in the general population. Electronic databases were searched from January 1966 to December 2012, and studies were included where the main focus was on neuropathic pain prevalence and/or incidence, either as part of a specific neuropathic pain-related condition or as a global entity in the general population. We excluded studies in which data were extracted from pain or other specialist clinics or focusing on specific population subgroups. Twenty-one articles were identified and underwent quality assessment and data extraction. Included studies differed in 3 main ways: method of data retrieval, case ascertainment tool used, and presentation of prevalence/incidence rates. This heterogeneity precluded any meta-analysis. We categorised comparable incidence and prevalence rates into 2 main subgroups: (1) chronic pain with neuropathic characteristics (range 3-17%), and (2) neuropathic pain associated with a specific condition, including postherpetic neuralgia (3.9-42.0/100,000 person-years [PY]), trigeminal neuralgia (12.6-28.9/100,000 PY), painful diabetic peripheral neuropathy (15.3-72.3/100,000 PY), glossopharyngeal neuralgia (0.2-0.4/100,000 PY). These differences highlight the importance of a standardised approach for identifying neuropathic pain in future epidemiological studies. A best estimate of population prevalence of pain with neuropathic characteristics is likely to lie between 6.9% and 10%. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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            Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations.

            Robert H Dworkin, Miroslav M Backonja, Michael C Rowbotham … (2003)
            Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism-based approach.
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              The mechanisms of action of gabapentin and pregabalin.

              Graeme J. Sills (2006)
              Gabapentin and pregabalin are structurally related compounds with recognized efficacy in the treatment of both epilepsy and neuropathic pain. The pharmacological mechanisms by which these agents exert their clinical effects have, until recently, remained unclear. The interaction of gabapentin and pregabalin with conventional antiepileptic and analgesic drug targets is likely to be modest, at best, and has been largely dismissed in favour of a selective inhibitory effect on voltage-gated calcium channels containing the alpha2delta-1 subunit. This mechanism is consistently observed in both rodent- and human-based experimental paradigms and may be sufficiently robust to account for much of the clinical activity of these compounds.
              Article 0 comments Cited 114 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Giorgio Cruccu: giorgio.cruccu@uniroma1.it
                Andrea Truini: andrea.truini@uniroma1.it
                Journal
                Journal ID (nlm-ta): Pain Ther
                Journal ID (iso-abbrev): Pain Ther
                Title: Pain and Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 2193-8237
                ISSN (Electronic): 2193-651X
                Publication date (Electronic): 24 November 2017
                Publication date PMC-release: 24 November 2017
                Publication date (Print): December 2017
                Volume: 6
                Issue: Suppl 1
                Pages: 35-42
                Affiliations
                GRID grid.7841.a, Department of Neurology and Psychiatry, , Sapienza University of Rome, ; Rome, Italy
                Article
                Publisher ID: 87
                DOI: 10.1007/s40122-017-0087-0
                PMC ID: 5701894
                PubMed ID: 29178033
                SO-VID: 9e8cad9d-a2b9-4d03-bf98-a6ca88f6ddf1
                Copyright © © The Author(s) 2017
                History
                Date received : 12 October 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004319, Pfizer;
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer Healthcare Ltd., part of Springer Nature 2017

                Keywords: analgesia,diagnosis,guidelines,neuropathic pain,quality of life,treatment
                Data availability:
                Keywords: analgesia, diagnosis, guidelines, neuropathic pain, quality of life, treatment

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