Treatment of neuropathic pain

ABSTRACT

Neuropathic pain presents a therapeutic challenge because patients cannot be relieved from it, even when all known medical options have been tried. Several treatment guidelines have been provided, and several pharmacotherapies have been proposed with non-pharmacological treatments. This study aimed to present the current pharmacological and non-pharmacological treatments used to treat patients with neuropathic pain. Furthermore, several treatment guidelines for neuropathic pain are compared.Current Concepts: Tricyclic antidepressants, gabapentinoids, and serotonin-norepinephrine reuptake inhibitors are the first-line agents recommended by clinical guidelines in several countries. Tramadol and topical agents are recommended as second-line agents. Opioids and cannabinoids are recommended as third-line agents; cannabinoids are recommended by Canadian treatment guidelines. Combination therapy may be more effective because it results in synergistic pain-relieving effects, and the individual drug dose may be lower. Non-pharmacologic treatment is recommended as third-line or supplementary management because of the lack of evidence.Discussion and Conclusion: Several guidelines have recommended similar drugs; however, it is impossible to completely cure neuropathic pain. Therefore, therapeutic goals must be realistically discussed to improve patient compliance. In addition, additional studies based on pathophysiological mechanisms should be conducted to improve the management of neuropathic pain.