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Issue: Issue 2 (2015)


Review Article

Pharmacological treatment of neuropathic pain: review of oral and topical therapy recommendations

Author(s):
Daniela Amorim
Abstract:
Background: Neuropathic pain is defined as pain initiated or caused by injury or disease of the somatosensory system. It is a chronic pain with an extremely high impact on patients quality of life, which is progressively incapacitating. This paper reviews the evidence-based guidelines on the management of neuropathic pain, aiming at establishing specific and targeted recommendations based on oral and topical drugs available in Portugal.

Methods: We reviewed the literature on the treatment of neuropathic pain from Medline and Cochrane databases. Guidelines proposed by several global organizations and implemented clinically in patients with different neuropathic pain conditions were analyzed and compared. The present recommendations focus on oral and topical drugs available in Portugal.

Recommendations: Recommendations for the treatment of neuropathic pain are based on three therapeutic lines. For best use of therapeutic resources, the evaluation of neuropathic condition is essential, allowing a detailed breakdown of drugs. In general, first-line therapy comprises tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, calcium channels alpha 2 delta ligands and topical lidocaine. Second-line therapy includes strong opioids and tramadol. Third-line therapy includes other antidepressants and anticonvulsants, N-methyl-D-aspartate (NMDA) receptor antagonists, topical capsaicin and gamma-aminobutyric acid (GABA) B receptor agonists. Combination therapy is also recommended.

Conclusion: Confirmatory diagnosis of neurological injury is essential to proper orientation of therapeutic strategies. An assessment of comorbidities and complete characterization of the neuropathic condition is recommended to establish specific profiles and provide individualized treatment.

Keywords: Neuropathic pain, Pharmacological management, Neuropathic pain syndromes.

International Journal of Clinical Neurosciences and Mental Health 2015; 2:4

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