Chronic Neuropathic Pain: Mechanisms, Diagnosis, and Treatment

  title={Chronic Neuropathic Pain: Mechanisms, Diagnosis, and Treatment},
  author={Robert Norman Harden},
  journal={The Neurologist},
  • R. Harden
  • Published 1 March 2005
  • Medicine
  • The Neurologist
Background:The management of chronic pain represents a significant public health issue in the United States. It is both costly to our health care system and devastating to the patient's quality of life. The need to improve pain outcomes is reflected by the congressional declaration of the present decade as the “Decade of Pain Control and Research,” and the acknowledgment in January 2001 of pain as the “fifth vital sign” by the Joint Commission of Healthcare Organizations. Review Summary:At… 

Surgical Management of Painful Neuromas

Recently published studies involving epidemiological surveys in Europe suggested neuropathic pain to have a prevalence of 7–8% in the general population, and pain intensity and duration are reported to be higher in comparison to chronic pain without neuropathic characteristics.

Pharmacotherapy for Neuropathic Pain

  • K. Jackson
  • Medicine
    Pain practice : the official journal of World Institute of Pain
  • 2006
In refractory patients, combination therapy using two agents with synergistic mechanisms of action may offer greater pain relief without compromising the side‐effect profile of each agent.

Neuropathic pain: symptoms, models, and mechanisms

The relationships between clinical symptoms and experimental models of peripheral neuropathic pain are described, and a framework for understanding the potential mechanisms that involve primary neuronal dysfunction as well as pathological changes in neuron‐glial signaling is provided.

The impact of neuropathic pain on health-related quality of life

The results provide strong evidence that the presence and severity of neuropathic pain are associated with greater impairments in a number of important HRQoL domains and suggest that a biopsychosocial approach would be appropriate for understanding and treating neuropathicPain.

Pathophysiology of neuropathic pain.

  • C. Pasero
  • Medicine
    Pain management nursing : official journal of the American Society of Pain Management Nurses
  • 2004

Opioid Self-Administration in the Presence of Chronic Pain: Analgesia or Addiction?

There is a need to understand mechanisms throughWhich chronic pain produces suffering and limits productivity, as well as mechanisms through which opioids produce addiction and abuse both in the presence and absence of pain.

An Update on the Pharmacological Management of Post-Herpetic Neuralgia and Painful Diabetic Neuropathy

Although a number of drug treatments are available for the symptomatic relief of neuropathic pain symptoms, these agents do not provide satisfactory relief in all patients and other treatment alternatives such as combination drug therapy that produces pain relief via distinctly different mechanisms may be successful.

Symptom-Based Treatment of Neuropathic Pain in Spinal Cord-Injured Patients: A Randomized Crossover Clinical Trial

The phenotype of neuropathic pain was associated with the efficacy of different pharmacologic treatments, therefore, Symptom-based treatment can lead to more efficient analgesia.

Symptom-based characteristics and treatment efficacy of neuropathic pain related to spinal disorders.




Neurogenic pain syndromes and their management.

  • D. Bowsher
  • Medicine, Psychology
    British medical bulletin
  • 1991
The clinical syndromes representing this type of disorder make up at least 25% of the patients attending most pain clinics, and is a measure of its intractability and of the therapeutic dilemma which it presents.

Neuropathic pain in cancer patients: mechanisms, syndromes, and clinical controversies.

Overview of neuropathic pain syndromes

  • J. Serra
  • Medicine, Psychology
    Acta neurologica Scandinavica. Supplementum
  • 1999
Therapy will be more symptom‐oriented than illness‐oriented, and treatment options will most likely be tailored to fit the specific constellation of symptoms expressed by a particular patient.

The Treatment of Neuropathic Pain: Antidepressants and Opiodis

First‐line therapy for neuropathic pain may be either an older generation antidepressant such as amitriptyline or nortripty line or the anticonvulsant gabapentin, and evidence is accumulating that this approach is safe if proper guidelines are observed.

Neuropathic orofacial pain part 1--prevalence and pathophysiology.

  • E. R. VickersM. Cousins
  • Medicine
    Australian endodontic journal : the journal of the Australian Society of Endodontology Inc
  • 2000
The patient afflicted with neuropathic oral/orofacial pain may present to the dentist with a persistent, severe pain, yet there are no clearly identifiable clinical or radiographic abnormalities, and multiple endodontic procedures may be instigated to remove the likely anatomical source of the pain,yet the pain persists.

The evolving role of antiepileptic drugs in treating neuropathic pain.

  • E. Ross
  • Medicine, Psychology
  • 2000
Recent newer AEDs with more favorable side-effect profiles have been tested in placebo-controlled clinical trials for the treatment of neuropathic pain, and provide the basis for reevaluating some of the commonly accepted paradigms that guide approaches to treatment.

Complex Regional Pain Syndromes: guidelines for therapy.

This algorithm is a departure from the contemporary heterogeneous approach to treatment of patients with CRPS, and the underlying principles are motivation, mobilization, and desensitization facilitated by the relief of pain and the use of pharmacologic and interventional procedures to treat specific signs and symptoms.

Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life.