Pharmacological and interventional treatments for neuropathic pain

Neuropathic pain originates from a lesion within the central or peripheral nervous system. The signs of neuropathic pain include heat hyperalgesia, mechanohyperalgesia, and mechanoand cold allodynia. Traditionally, neuropathic pain responds poorly to conventional analgesics. This chapter will provide recommendations for medical and interventional management of neuropathic pain conditions based on the best scientific evidence in the literature. Anticonvulsants (e.g., gabapentin and pregabalin), antidepressants (e.g., amitritpyline and duloxetine), and topical lidocaine have been the most consistent Correspondence/Reprint request: Dr. Paul J. Christo, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 301, Baltimore Maryland 21205, USA. E-mail: [email protected] Bryan S. Williams & Paul J. Christo 296 in demonstrating effectiveness through randomized control trials. Certain circumstances may require the use of opioids as a first-line treatment for specific neuropathic pain states. Interventional strategies such as neural blockade, implantable drug delivery systems, and spinal cord stimulation can be beneficial for alleviating painful neuropathic conditions that respond less favorably to medical therapies, or as a method of augmenting current medical therapies. A rational approach for the treatment of specific neuropathic conditions is presented in the form of tables that consider first line, second line, and other therapies.