Neuropathic Pain Management: A Review

Most patients with neuropathic pain (NP) benefit most from an individualized, multimodal approach that emphasizes both pain and function, according to a review published in Medical Clinics of North America.1

Neuropathic pain arises from injuries or diseases affecting the somatosensory component at any level of the peripheral or central nervous system, and is diagnosed based on common neurologic signs and symptoms present in the patient history or on physical exam, write Miroslav Backonja, MD, from the department of neurology at the University of Wisconsin-Madison, and colleagues.

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“Recognizing neuropathic pain conditions for what they are is a vital part of treatment — these conditions are often much more challenging to treat than nociceptive pain conditions, and much more debilitating for people experiencing them,” Bob Twillman, PhD, executive director of the American Academy of Pain Management in Sonora, California, told Clinical Pain Advisor.

Study data suggest that NP affects up to 8% of adults worldwide, and tends to be more severe and associated with poorer outcomes than non-neuropathic pain.Although using multiple therapeutic approaches to treat neuropathic pain is most effective, no specific combination works for all patients, highlighting the need for personalized therapy.

“Once neuropathic pain is identified, treatment can be specifically tailored to achieve better outcomes more quickly,” Dr. Twillman pointed out.

Intended to provide internal medicine and primary care physicians with the most current information regarding the management of neuropathic pain, the review outlined NP assessment and diagnosis, and also provided insight into treatment planning, implementation, and monitoring.

Diagnosis and Goal-Setting

Neuropathic pain is commonly underdiagnosed, and often undertreated. However, increased awareness among clinicians can improve the likelihood of a correct diagnosis, Dr. Backonja told Clinical Pain Advisor.

“Neuropathic pain has characteristic signs that differentiate it from other types of pain. There are assessment tools and approaches that can be used to specifically diagnose neuropathic pain, such as the Neuropathic Pain Questionnaire,” Dr. Backonja said.