Management of Neuropathic Pain: Challenges and Opportunities

Neuropathic pain may result from a wide spectrum of insults to the peripheral or central nervous system. This may include nutritional deficiencies, systemic diseases, chemotherapy, cerebrovascular accident, surgery or trauma. The hallmark of neuropathic pain is abnormal neural activity in peripheral nerve(s) or the central nervous system. This is often accompanied by disordered sensory processing both in the peripheral or central nervous system. Treating neuropathic pain is a major clinical challenge, and the underlying mechanisms of neuropathic pain remain elusive. The present review highlights pathophysiology of neuropathic pain and difficulty in treating the symptoms associated with it. This reflects our poor understanding of the pathophysiological processes which lead to neuropathic pain as well as the limited usefulness of many of our pharmacologic agents. An improved understanding of the pathophysiology of neuropathic pain as a result of laboratory research as well as novel means of delivering currently available drugs have provided us with an improved ability to treat certain types of neuropathic pain. Despite these advances, neuropathic pain remains extremely challenging to treat in the best of hands.