While there are several mainstay treatments for the management of neuropathic pain, recent advancements may provide alternative approaches to this troubling syndrome without a high burden of adverse effects. A recent review article published in Annals of Translational Medicine highlights these treatment advancements in neuropathic pain.

According to literature, the most effective treatment options for neuropathic pain include tricyclic antidepressants (TCAs), gabapentinoids, lidocaine, serotonin norepinephrine reuptake inhibitors, and capsaicin. But newer treatment options and interventional strategies have emerged, many of which have demonstrated promising clinical efficacy in recent trials.

Certain infusion therapies, particularly those that include oxytocin, may provide pain modulation effects that could manage neuropathic pain, according to some research. Intravenous bisphosphonates have also demonstrated efficacy in refractory cases of complex regional pain syndrome. In contrast, intravenous medications lidocaine and ketamine are currently the most commonly used infusion therapies for neuropathic pain.

Low-temperature plasma radiofrequency ablation (coblation) technology represents a novel neuroablative procedure approach for neuropathic pain. The new technology excites electrolytes through the use of radiofrequency energy, leading to the formation of energized plasma. Ultimately, coblation may suppress stimulation of dorsal root ganglion.


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Ultra-sounded cryoneurolysis is another approach to neuropathic pain. This strategy freezes nerves and prevents the conduction of nerve impulses to the sensory system. An ultra-sounded guided approach could be used for refractory neuropathic pain, some research suggest.

Intrathecal delivery of analgesic medications has also shown promise in small studies and preclinical trials. Botulinum toxin, for instance, may provide an effective treatment for neuropathic pain when delivered through intramuscular or intraarticular routes.

Additionally, neuromodulation has proven benefit in neuropathic pain when delivered with newer, improved technology. Neuromodulation’s therapeutic mechanism is not yet fully understood. Current thinking suggests neuromodulation’s therapeutic response is associated with peripheral, spinal cord/segmental, and supraspinal effects.

According to the researchers of the review, the future of novel interventional methods for neuropathic pain may lie in interventions with multimodal mechanisms as well as “interventions that offer longevity in therapy without tolerance.” They added that “as neuropathic pain continues to be a burden, the need to investigate and develop these novel methods becomes even more important.”

Reference

Varshney V, Osborn J, Chaturvedi R, Shah V, Chakravarthy K. Advances in the interventional management of neuropathic pain. Ann Transl Med. 2021;9(2):187. doi:10.21037/atm-20-6190