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Neuropathic Pain

Zilliox, Lindsay A. MD, MS

doi: 10.1212/CON.0000000000000462
Review Articles

ABSTRACT Purpose of Review: Neuropathic pain is a frequently encountered condition that is often resistant to treatment and is associated with poor patient satisfaction of their treatment. Several medications have been shown to be effective in treating neuropathic pain associated with diabetic neuropathy and postherpetic neuralgia, and these medications are often used to treat neuropathic pain associated with other conditions as well. This article summarizes the diagnosis and assessment of patients with neuropathic pain as well as available pharmacologic and interventional treatment options.

Recent Findings: Evidence-based recommendations for the treatment of neuropathic pain have been published, and first-line medications include antidepressants, anticonvulsants, topical agents, as well as opioid analgesics. Interventional options include anesthetic and steroid injections, nerve blocks, and spinal cord stimulation. Essential to the treatment algorithm of neuropathic pain is the assessment and treatment of psychosocial comorbidities and the utilization of a multidisciplinary team approach, including cognitive-behavioral and rehabilitative therapies. Questions remain about the comparative effectiveness of various medications and combination therapies. Increasing interest also exists in the optimization and personalization of pharmacotherapy based upon the underlying mechanism(s) of neuropathic pain according to the quality of the patient’s symptoms.

Summary: The management of chronic neuropathic pain is challenging and is best achieved with the use of a multidisciplinary team. Pain is a subjective experience, and it is important to validate a patient’s pain, address psychosocial comorbidities, and set realistic treatment goals. Evidence-based guidelines are available to guide treatment, but frequently, high-quality evidence-based recommendations are lacking.

Address correspondence to Dr Lindsay A. Zilliox, 110 S Paca St, 3rd floor, Baltimore, MD 21201,

Relationship Disclosure: Dr Zilliox has received salary support from the US Department of Veterans Affairs Career Development Grant.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Zilliox discusses the unlabeled/investigational use of duloxetine, gabapentin, lamotrigine, pregabalin, tricyclic antidepressants, valproic acid, and venlafaxine for the management of patients with neuropathic pain.

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© 2017 American Academy of Neurology
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