Klin Farmakol Farm. 2009;23(4):181-186

Pharmacotherapy of neuropathic pain

Dana Vondráčková

Centrum léčby bolesti FN Na Bulovce, Výukové pracoviště paliativní medicíny a léčby bolesti IPVZ, Praha

Pathophysiologically, neuropathic pain (NPP) is one of the types of pain. It can occur alone or together with nociceptive pain, as mixed

pain, in tumorous disease as well as for non-tumorous reasons. It is caused by a dysfunction of or damage to neural tissue at various

sites, ranging from the periphery to central structures. Neuropathic pain has a typical clinical presentation which is very diverse. An

underlying anatomic basis is not invariably found. One neuropathic syndrome may present with different symptoms. The treatment of

NPP is difficult and not always successful. Pharmacotherapy is the mainstay of treatment that may help achieve an acceptable intensity

of the pain. Anticonvulsants and tricyclic antidepressants (amitriptyline) are the first choice with opioids being the second. Some neuropathic

pain syndromes are so difficult to manage that invasive procedures have to be used, such as spinal blockage, sympathetic or

peripheral plexus blockage, and modern neuromodulation and radiofrequency techniques. Local treatment with lidocaine or capsaicin

can be used as adjunct therapy for NPP; local NSAIDs are minimally effective.

Keywords: neuropathic pain, anticonvulsants, antidepressants, opioids

Published: May 1, 2010  Show citation