The goals of NP management are very similar to that of traditional pain management strategies, which start with conservative therapies before advancing to more interventional approaches to improve pain control and quality of life as well as restore functions of daily living.
“The best results in treatment of patients with neuropathic pain are achieved when a multidisciplinary and multimodal approach is utilized,” Dr. Backonja said, noting that a team of physicians, nurses, and other staff often work together to care for these complex patients.
“Prescribing a medication is not sufficient. It takes a few medications to treat the primary problem, as well as comorbidities,” Dr. Backonja added, drawing a similarity between managing NP and other complex chronic conditions, such as diabetes, that require use of multiple medications and treatment modalities.
A Spectrum of Treatment Strategies
Treatment of NP involves patient education as well as conservative approaches, complementary medicine, pharmaceutical approaches, interventional methods, and surgical treatment modalities.
“Both complementary and integrated medicine have a role in the management of neuropathic pain. Such strategies include meditation, yoga, tai chi, and other modalities,” Dr. Backonja said.
A number of widely disseminated guidelines and consensus statements are available regarding NP medical therapy.
“It is fairly straightforward to prescribe medications that are used for treatment of neuropathic pain. Internal medicine physicians are familiar with gabapentin, duloxetine, and tricyclic antidepressants,” Dr. Backonja pointed out.
The review also offers a detailed discussion regarding opioids, which have demonstrated efficacy in treating neuropathic pain. “We generally hear that they are not effective for that purpose, but the truth really is that they can be — to some degree, and in the right patient,” Dr. Twillman noted.
“There are established assessment tools and diagnostic approaches so [that] neuropathic pain should not be underdiagnosed, and there are well-publicized treatment guidelines so [that] neuropathic pain should not be undertreated,” Dr. Backonja concluded. “The only thing remaining is to utilize them in primary care more widely.”
1. Jones RC 3rd, Lawson E, Backonja M. Managing Neuropathic Pain. Med Clin North Am. 2016 Jan;100(1):151-67. doi: 10.1016/j.mcna.2015.08.009. Epub 2015 Oct 28. Review.
2. Global year against neuropathic pain. International Association for the Study of Pain 2014-2015. Available at: http://iasp.files.cms-plus.com/AM/Images/GYAP/Epidemiology%20of%20Neuropathic%20Pain.pdf. Accessed: November 17, 2015.