Neuropathic Pain - Diagnostic and Therapeutic Update

Neuropathic pain syndromes, i.e., pain after a lesion or disease of the peripheral or central nervous system, are clinically characterised by spontaneous pain (ongoing, paroxysms) and evoked types of pain (hyperalgesia, allodynia). Beside the assessment of these typical clinical symptoms, the diagnosis is based on neurophysiological techniques with special emphasis on the small nociceptive fiber function. The medical management of neuropathic pain consists of 3 main classes of oral or transdermal medications (antidepressants with re-uptake blocking effect, anticonvulsants with Ca-modulating actions and opioids) and several categories of topical medications for patients with cutaneous allodynia and hyperalgesia (capsaicin and lidocaine). In many cases an early combination of compounds affecting different mechanisms is useful.