Management of patients with neuropathic pain

Abstract

Background: Neuropathic pain diseases commonly treated with pain medicine are postherpetic neuralgia (PHN), diabetic peripheral neuropathy (DPNP), complex regional pain syndrome (CRPS), and chronic pain after spinal surgery. Diagnosis and treatment of these neuropathic pain diseases is an arduous task, and there is a need to improve the understanding of these entities.Current Concepts: PHN is diagnosed when pain persists for more than 3 months after the healing of herpes zoster rashes, and this disease is commonly encountered in the elderly population. The pathophysiology of DPNP is ischemia of nerve tissue due to microvascular damage. In addition to sensory nerves, DPNP can also result in changes in motor and autonomic nerves. CRPS is a chronic intractable pain disorder, and is classified into types 1 and 2. Type 1 CRPS is diagnosed when there is no evidence of nerve damage while type 2 CRPS shows evidence of nerve damage. However, the signs and symptoms do not differ depending on the type. Chronic pain after spinal surgery is characterized by persistent back pain even after one or more spinal surgeries. This neuropathic pain occurs in the lower back or leg region.Discussion and Conclusion: The most crucial step in the management of patients with neuropathic pain is to suspect and diagnose if the pain has the characteristics of any pain-related disease. Although the etiology and pathophysiology may differ, the treatment of neuropathic pain remains the same and includes both conservative and interventional approaches. Neuropathic pain diseases often become chronic in nature, and thus, it is important to establish a treatment plan which aims at decreasing pain, improving patient’s functionality and attaining an acceptable quality of life.