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Markman, John D.; Hanson, Ross S.

CONTINUUM: Lifelong Learning in Neurology: October 2009 - Volume 15 - Issue 5, Neuropathic Pain - p 101-133
doi: 10.1212/01.CON.0000348857.43136.fb

Understanding the complementary role of interventional approaches in the treatment of chronic neuropathic pain is essential to optimizing analgesic benefit. Only a minority of patients experience both a significant reduction in pain intensity with tolerable side effects from drug therapy and behavioral approaches alone. Targeting the localized site of altered nociceptive processing along the neuraxis is a longstanding strategy adapted from the acute pain context. The myriad techniques range from reversible ion channel blockade of a peripheral nerve with a local anesthetic to continuous modulation of spinal cord signaling with electrical stimulation. The three principal domains of interventional techniques are: (1) ablation, (2) augmentation, and (3) anatomic modification. The risks and benefits must be assessed in both a condition-specific and technology-specific fashion. This chapter will also consider the improvement in therapeutic index potentially offered by neuraxial delivery of drugs through the intrathecal, epidural, and perineural routes of administration.

Relationship Disclosure: Dr Markman has received personal compensation for serving on the advisory board of Johnson & Johnson. Dr Markman has received research support from Endo Pharmaceuticals and Pfizer Inc.

Mr Hanson has nothing to disclose.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Markman and Mr Hanson discuss the unlabeled use of many procedures in his chapter.

© 2009 American Academy of Neurology
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