General practice Terapia 2019, 9 ( 380 ) : 40 - 52
Neuropathic pain – new therapeutic possibilities. The role of co-analgesics in the treatment of neuropathic pain
Summary:
Neuropathic pain is a complex phenomenon which is not yet fully comprehended. It is commonly encountered in everyday clinical practice, where it constitutes a therapeutic challenge due to its usual high intensity and resistance to commonly used analgesics. Neuropathic pain occurs in 6.9–8.2% of the adult population. In 2014, the Polish Association for the Study of Pain and the Polish Neurological Society published recommendations regarding the diagnosis and treatment of neuropathic pain, based on an overview of global publications and in accordance with evidence-based medicine. The paper presents a new definition of neuropathic pain, along with the mechanism of its development, methods and tools useful for the diagnosis of this type of pain, epidemiology and recommendations regarding the pharmacotherapy of the most common peripheral and central neuropathic pain syndromes. Neuropathic pain can be recognized based on medical history and a clinical examination focused on sensory disorders. Co-analgesics, or antidepressants (tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors), as well as anticonvulsants such as pregabalin and gabapentin, are fundamental for neuropathic pain treatment. Weak and strong opioids are used less often. Localized pain is treated with 8% capsaicin and 5% lidocaine patches. Lidocaine intravenous infusions have also been proven to be effective. In the case of pain resistant to pharmacotherapy, interventional methods are used in selected cases: regional blocks, thermolesion, surgical treatment. The treatment of neuropathic pain requires an individual course of action and a gradual selection of drugs that are best suited for the patient in order to achieve the desirable therapeutic effect.
Keywords: neuropathic pain, diagnosis of neuropathic pain, pharmacology, management of neuropathic pain, anticonvulsants, pregabalin, antidepressants
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