Summary:
Neuropathic pain is caused by inadequate repair and adaptive capacities of the nervous system associated with its damage or disease. The diagnosis and evaluation of neuropathic pain, at a basic level, should be based on a detailed history taken from the patient, a physical examination (including a neurological examination), a drawing of the pain, a verbal description of the nature of the complaint, pain assessment questionnaires/scales, and a review of somatosensory function. Occasionally, additional imaging, electrophysiological and laboratory tests, quantitative sensory testing, skin or nerve biopsy or laser evoked potential testing may be necessary to obtain a proper diagnosis. Treatment of neuropathic pain remains a significant challenge, due to the lack of fully effective management methods. Therapy should include multidirectional interactions, which, if possible, should target the causes of pain. In most patients, symptomatic management based on pharmacotherapy is used. In cancer patients with active disease, opioid analgesics play an important role, especially those showing complex mechanisms of action: on the second step of the WHO analgesic ladder tramadol, on the third step: tapentadol, buprenorphine and methadone. In patients with chronic pain of non-cancer origin and in patients after successful (no signs of recurrence) anti-cancer treatment, adjuvant analgesics are the first line of treatment. The most commonly used are anticonvulsants, especially pregabalin, mirogabalin and gabapentin, less frequently (valproic acid, oxcarbazepine). The second frequently used group of analgesic adjuvants are antidepressants, especially from the group of serotonin and norepinephrine reuptake blockers: duloxetine and venlafaxine, as well as tricyclics (amitriptyline, nortriptyline), which, however, have an unfavorable side effect profile, especially in older patients. The use of corticosteroids and intravenous lignocaine infusions may be beneficial. In localized neuropathic pain, topical therapy (lignocaine in patches, capsaicin and botulinum toxin) plays an important role. In some patients, pain intervention techniques, antineoplastic therapy and non-pharmacological management may be effective.
Keywords: analgesic adjuvants, opioid analgesics, neuropathic pain, treatment
If you would like to get the full article in Polish please contact our editorial office via email.
Add new comment