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Management of painful neuropathies

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Opinion statement

Inadequately assessed and poorly managed pain contributes both to high general medical cost and to increasing numbers of societal problems. A large determining factor of inadequate pain care is the lack of understanding about the complex nature of pain and of a rational approach to its assessment and treatment. The less than adequate assessment of neuropathic pain and its relatively poor response to typical analgesic medications are major determinants to the undertreatment of pain. Other than the important management concept of treating the underlying cause, current approaches to the treatment of pain in general, and neuropathic pain in particular, have shifted away from treatment of individual syndromes toward the identification and management of common symptoms and the mechanisms upon which such symptoms are presumed to be based. This article summarizes the features of neuropathic pain that commonly appear in most peripheral neuropathies, regardless of the mechanism of injury, and provides an approach for the selection of treatment.

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References and Recommended Reading

  1. Gilron I, Watson CPN, Cahill CM, Moulin DE: Neuropathic pain: a practical guide for the clinician. CMAJ 2006, 175:265–283.

    PubMed  Google Scholar 

  2. Stacey BR: Management of peripheral neuropathic pain. Am J Phys Med Rehabil 2005, 84:S4–S18.

    PubMed  Google Scholar 

  3. Wolfe GI, Trivedi JR: Painful peripheral neuropathy and its nonsurgical treatment. Muscle Nerve 2004, 30:3–19.

    Article  PubMed  CAS  Google Scholar 

  4. Dworkin RH, Jensen MP, Gammaitoni AR, et al.: Symptom profiles differ in patients with neuropathic versus non-neuropathic pain. J Pain 2006, In press.

  5. Woolf CJ: Dissecting out mechanisms responsible for peripheral neuropathic pain: implications for diagnosis and therapy. Life Sci 2004, 74:2605–2610.

    Article  PubMed  CAS  Google Scholar 

  6. Campbell JN, Meyer RA: Mechanisms of neuropathic pain. Neuron 2006, 52:77–92.

    Article  PubMed  CAS  Google Scholar 

  7. Gallagher RM: Management of neuropathic pain: translating mechanistic advances and evidence-based research into clinical practice. Clin J Pain 2006, 22:S2–S8.

    Article  PubMed  Google Scholar 

  8. Gilron I, Baily JM, Tu D, et al.: Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005, 352:1324–1334.

    Article  PubMed  CAS  Google Scholar 

  9. Simpson DA: Gabapentin and venlafaxine for the treatment of painful diabetic neuropathy. J Clin Neuromusc Disease 2001, 3:53–62.

    Article  CAS  Google Scholar 

  10. Finnerup NB, Otto M, McQuay HJ, et al.: Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005, 118:289–305.

    Article  PubMed  CAS  Google Scholar 

  11. Slipman CW, Issac Z: The role of diagnostic selective nerve root blocks in the management of spinal pain. Pain Physician 2001, 4:214–226.

    PubMed  CAS  Google Scholar 

  12. Haythornthwaite JA, Benrud-Larsen LM: Psychological aspects of neuropathic pain. Pain 2000, 16:S101–S105.

    CAS  Google Scholar 

  13. Turk DC: Understanding pain sufferers: the role of cognitive processes. Spine J 2004, 4:1–7.

    Article  PubMed  Google Scholar 

  14. Cheing GL, Luk ML: Transcutaneous electrical nerve stimulation for neuropathic pain. J Hand Surg [Br] 2005, 30:50–55

    CAS  Google Scholar 

  15. Rosted P, Andersen C: Use of stimulation techniques in pain treatment. Ugeskr Laeger 2006, 168:1982–1986.

    PubMed  Google Scholar 

  16. Buenaver LF, McGuire L, Haythornthwaite JA: Cognitive-behavioral self-help for chronic pain. J Clin Psychol 2006, 62:1389–1396.

    Article  PubMed  Google Scholar 

  17. Turk DC: Cognitive-behavioral approach to the treatment of chronic pain patients. Reg Anesth Pain Med 2003, 28:573–579.

    Article  PubMed  Google Scholar 

  18. Gilron I, Flatters SJ: Gabapentin and pregabalin for the treatment of neuropathic pain: a review of laboratory and clinical evidence. Pain Res Manag 2006, 11(Suppl A):16A–29A.

    Google Scholar 

  19. Backonja M, Beydoun A, Edwards KR, et al.: Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998, 280:1831–1836.

    Article  PubMed  CAS  Google Scholar 

  20. Rowbotham MC, Harden N, Stacey B, et al.: Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998, 280:1837–1842.

    Article  PubMed  CAS  Google Scholar 

  21. Dogra S, Beydoun S, Mazzola J, et al.: Oxcarbazepine in painful diabetic neuropathy: a randomized, placebo-ontrolled study. Eur J Pain 2005, 9:543–554.

    Article  PubMed  CAS  Google Scholar 

  22. Eisenberg E, Lurie Y, Braker C, et al.: Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology 2001, 57:505–509.

    PubMed  CAS  Google Scholar 

  23. Simpson DM, McArthur JC, Olney R, et al.: Lamotrigine for HIV-associated painful sensory neuropathies: a placebo-controlled trial. Neurology 2003, 60:1508–1514.

    PubMed  CAS  Google Scholar 

  24. Raskin P, Donofrio PD, Rosenthal NR, et al.: Topiramate vs. placebo in painful diabetic neuropathy: analgesic and metabolic effects. Neurology 2004, 63:865–873.

    PubMed  CAS  Google Scholar 

  25. Thienel U, Neto W, Schwabe SK, Vijapurkar U: Topiramate in painful diabetic polyneuropathy: findings from three double-blind placebo-controlled trials. Acta Neurol Scand 2004, 110:221–231.

    Article  PubMed  CAS  Google Scholar 

  26. Kochar DK, Rawat M, Agrawal RP, et al.: Sodium valproate in the management of painful neuropathy in type 2 diabetes—a randomized placebo controlled study. QJM 2004, 97:33–38.

    Article  PubMed  CAS  Google Scholar 

  27. Otto M, Bach FW, Jensen TS, Sindrup SH: Valproic acid has no effect on pain in polyneuropathy: a randomized controlled trial. Neurology 2004, 62:285–288.

    PubMed  CAS  Google Scholar 

  28. Kochar DK, Garg P, Bumb RA, et al.: Divalproex sodium in the management of post-herpetic neuralgia: a randomized double-blind placebo-controlled study. QJM 2005, 98:29–34.

    Article  PubMed  CAS  Google Scholar 

  29. Guay DR: Oxcarbazepine, topiramate, zonisamide, and levetiracetam: potential use in neuropathic pain. Am J Geriatr Pharmacother 2003, 1:18–37.

    Article  PubMed  CAS  Google Scholar 

  30. Atli A, Dogra S: Zonisamide in the treatment of painful diabetic neuropathy: a randomized, double-blind, placebo-controlled pilot study. Pain Med 2005, 6:225–234.

    Article  PubMed  Google Scholar 

  31. Kinloch RA, Cox PJ: New targets for neuropathic pain therapeutics. Expert Opin Ther Targets 2005, 9:685–698.

    Article  PubMed  CAS  Google Scholar 

  32. McCleane G: Intravenous infusion of phenytoin relieves neuropathic pain: a randomized, double-blinded, placebo-controlled, crossover study. Anesth Analg 1999, 89:985–988.

    Article  PubMed  CAS  Google Scholar 

  33. Richter RW, Portenoy R, Sharma U, et al.: Relief of painful diabetic neuropathy with pregabalin: a randomized, placebo-controlled trial. J Pain 2005, 4:253–260.

    Article  CAS  Google Scholar 

  34. Dworkin RH, Corbin AE, Young JP Jr, et al.: Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2003, 60:1274–1283.

    PubMed  CAS  Google Scholar 

  35. Sabatowski R, Galvez R, Cherry DA, et al.: Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 2004, 109:26–35.

    Article  PubMed  CAS  Google Scholar 

  36. Mico JA, Ardid D, Berrocoso E, Eschalier A: Antidepressants and pain. Trends Pharmacol Sci 2006, 27:348–354.

    Article  PubMed  CAS  Google Scholar 

  37. Rowbotham MC, Goli V, Kunz NR, Lei D: Venlafaxine extended release in the treatment of painful diabetic polyneuropathy: a double-blind, placebo-controlled study. Pain 2004, 110:697–706.

    Article  PubMed  CAS  Google Scholar 

  38. Goldstein DJ, Lu Y, Detke MJ, et al.: Duloxetine vs placebo in patients with painful diabetic neuropathy. Pain 2005, 116:109–118.

    Article  PubMed  CAS  Google Scholar 

  39. Watson CP: Management issues of neuropathic trigeminal pain from a medical perspective. J Orofac Pain 2004, 18:366–373.

    PubMed  Google Scholar 

  40. Sememchuk MR, Sherman S: Effectiveness of tizanidine in neuropathic pain: an open-label study. J Pain 2000, 1:285–292.

    Article  Google Scholar 

  41. Gimbel JS, Richards P, Portenoy RK: Controlled-release oxycodone for pain in diabetic neuropathy. A randomized controlled trial. Neurology 2003, 60:927–934.

    PubMed  CAS  Google Scholar 

  42. Moulin DE, Palma D, Watling C, Schulz V: Methadone in the management of intractable neuropathic noncancer pain. Can J Neurol Sci 2005, 32:340–343.

    PubMed  CAS  Google Scholar 

  43. Boureau F, Legallicier P, Kabir-Ahmadi M: Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Pain 2003, 104:323–331.

    Article  PubMed  CAS  Google Scholar 

  44. Gammaitoni AR, Alvarez NA, Galer BS: Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature. J Clin Pharmacol 2003, 43:111–117.

    Article  PubMed  CAS  Google Scholar 

  45. Dworkin RH, Backonja M, Rowbotham MC, et al.: Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003, 60:1524–1534.

    Article  PubMed  Google Scholar 

  46. Bonezzi C, Demartini L: Treatment options in postherpetic neuralgia. Acta Neurol Scand Suppl 1999, 173:25–35.

    Article  PubMed  CAS  Google Scholar 

  47. Zeigler D, Lynch SA, Muir J, et al.: Transdermal clonidine versus placebo in painful diabetic neuropathy. Pain 1992, 48:403–408.

    Article  PubMed  CAS  Google Scholar 

  48. Watson CP, Tyler KL, Bickers DR, et al.: A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 1993, 15:510–526.

    PubMed  CAS  Google Scholar 

  49. Paice JA, Ferrans CE, Lashely FR, et al.: Topical capsaicin in the management of HIV-associated peripheral neuropathy. J Pain Symptom Manage 2000, 19:45–52.

    Article  PubMed  CAS  Google Scholar 

  50. Capsaicin Study Group: Treatment of painful diabetic neuropathy with topical capsaicin. A multicenter, double-blind, vehicle-controlled study. Arch Intern Med 1991, 151:2225–2229.

    Article  Google Scholar 

  51. McCleane G: Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study. Br J Clin Pharmacol 2000, 49:574–579.

    Article  PubMed  CAS  Google Scholar 

  52. Seghier ML, Lazeyras F, Vuilleumier P, et al.: Functional magnetic resonance imaging and diffusion tensor imaging in a case of central poststroke pain. J Pain 2005, 6:208–212.

    Article  PubMed  Google Scholar 

  53. Audette JF, Ryan AH: The role of acupuncture in pain management. Phys Med Rehabil Clin N Am 2004, 15:749–772.

    PubMed  Google Scholar 

  54. Chandler Iii GS, Nixon B, Stewart LT, Love J: Dorsal column stimulation for lumbar stenosis. Pain Physician 2003, 6:113–118.

    Google Scholar 

  55. Paicius RM, Bernstein CA, Lempert-Cohen C: Peripheral nerve field stimulation in chronic abdominal pain. Pain Physician 2006, 9:261–266.

    PubMed  Google Scholar 

  56. Sindou M, Mertens P: Neurosurgical management of neuropathic pain. Stereotact Funct Neurosurg 2000, 75:76–80.

    Article  PubMed  CAS  Google Scholar 

  57. Krames E: Implantable devices for pain control: spinal cord stimulation and intrathecal therapies. Best Pract Res Clin Anaesthesiol 2002, 16:619–649.

    Article  PubMed  Google Scholar 

  58. Regis J, Metellus P, Dufour H, et al.: Long-term outcome after gamma knife surgery for secondary trigeminal neuralgia. J Neurosurg 2001, 95:199–205.

    PubMed  CAS  Google Scholar 

  59. Rog DJ, Nurmikko TJ, Friede T, Young CA: Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005, 65:812–819.

    Article  PubMed  Google Scholar 

  60. Perez J: Combined cannabinoid therapy via an oromucosal spray. Drugs Today 2006, 42:495–503.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology and Neuroscience Pain Mastery and Rehabilitation Center of Louisiana, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA

    Harry J. Gould III

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  1. Harry J. Gould III
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Correspondence to Harry J. Gould III.

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Gould, H.J. Management of painful neuropathies. Curr Treat Options Neurol 9, 75–84 (2007). https://doi.org/10.1007/s11940-007-0033-2

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