Neuropathic pain in peripheral nerve damage: mechanisms of development and overcoming (literature review)

Abstract

Peripheral nerve damage caused by trauma, surgery, or some diseases is common in clinical practice and may be accompanied by the development of neuropathic pain. Nerves injuries are caused by car and labor accidents, by cutting and penetrating objects, crushing, fractures, stretching and gunshot wound, professional or amateur sportsmen injuries. Chronic post-surgical pain is a major clinical problem. Incidence of chronic post-surgical pain varies depending on the type of surgery and surgical technique – after limb amputation, thoracotomy, mastectomy, hysterectomy, hip arthroplasty, cholecystectomy, colectomy, vasectomy, Cesarean section. Such pain can transform into persistent, severe and refractory chronic neuropathic pain, which is a serious social problem because it often affects the most productive population, sometimes causing disability, have a high level of comorbidity in the form of psychopathological conditions, sleep disorders. The pathophysiology and neurotransmission of neuropathic pain have complex and not fully understood mechanisms. They involve produce local and systemic signal pain cytokines, disturbances in the modulation of sensory flows, peripheral and central sensitization, neurotransmitter imbalance, changes in gene expression and implicate of the limbic system and hypothalamus contribute to the modulation of mood and behavior. Options for managing neuropathic pain with nerve damage include a limited number of pharmacological drugs and interventional treatment methods. Main drugs used in relief in neuropathic pain include tricyclics antidepressants and dual norepinephrine/5 hydroxytryptamine reuptake inhibitors, gabapentinoids – gabapentin and pregabalin, capsaicin, opioid analgesics, especially tramadol and methadone are recommended as second line drugs. For patient’s refractory to pharmacotherapy, neurosurgical decompression and nerve reconstruction and neuromodulation procedures are recommended to relieve neuropathic pain. Keywords: chronic pain, persistent postsurgical pain, peripheral sensitization, pharmacotherapy.