Neuropathic pain
Pro Research Analysisby 
Searched over 200M research papers for "neuropathic pain"
Understanding Neuropathic Pain: Definitions, Mechanisms, and Management
Definition and Classification of Neuropathic Pain
Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system1 3. This type of pain is distinct from nociceptive pain, which results from the activation of nociceptive afferents by tissue-damaging stimuli. The International Association for the Study of Pain (IASP) has refined the definition to better fit the nosology of neurological disorders, emphasizing the involvement of the somatosensory system1.
A grading system has been proposed to classify neuropathic pain into definite, probable, and possible categories. This system is based on clinical findings and requires confirmatory evidence from neurological examinations for the probable and definite grades1 3. Despite its utility, the grading system has seen limited adoption due to uncertainties about confirmatory tests and the role of screening tools3.
Mechanisms Underlying Neuropathic Pain
Neuropathic pain results from maladaptive plasticity within the nociceptive system, leading to spontaneous pain and amplified responses to stimuli9 10. Key mechanisms include ectopic generation of action potentials, synaptic facilitation and disinhibition, loss of synaptic connectivity, and neuroimmune interactions9 10. These changes can occur at various sites, including nerve-end neuromas, compressed nerves, dorsal root ganglia, and the thalamus5.
Peripheral and central sensitization play crucial roles in the pathophysiology of neuropathic pain. Structural changes, alterations in ion channels, activation of immune cells, and epigenetic regulation contribute to the sensitization of nociceptive pathways5. These complex mechanisms underscore the need for targeted therapeutic strategies.
Epidemiology and Impact on Quality of Life
Neuropathic pain can arise from various conditions, including trigeminal neuralgia, painful polyneuropathy, postherpetic neuralgia, and central poststroke pain5. The prevalence of neuropathic pain in the general population is estimated to be between 6.9% and 10%6. Patients with neuropathic pain often experience significant impairments in health-related quality of life (HR-QOL), including reduced mobility, work ability, and social interactions4.
Management Strategies for Neuropathic Pain
Managing neuropathic pain is challenging and typically requires a multifaceted approach. Pharmacologic treatments with strong supporting evidence include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and certain antiseizure agents2 7. Emerging evidence suggests potential benefits from cannabinoids, although conclusive studies are lacking2.
Nonpharmacologic therapies such as acupuncture, massage therapy, and reflexology are used as adjunctive treatments, but the evidence supporting their efficacy is not robust2. Combination therapies are often employed to enhance pain relief and improve HR-QOL2 4.
Clinical Implications and Future Directions
Diagnosing neuropathic pain involves a careful clinical assessment, supported by imaging techniques, electrophysiological examinations, and skin biopsies7. Treatment should ideally be individualized based on the underlying mechanisms, although current practices often lack precision7.
Future research should focus on improving diagnostic tools, understanding the full societal costs of neuropathic pain, and developing disease-modifying treatments that prevent maladaptive plasticity and reduce intrinsic risk factors9 10. Enhanced clinical trials comparing different therapies using HR-QOL and utility outcomes are also needed to guide effective management strategies4.
Conclusion
Neuropathic pain is a complex and debilitating condition resulting from lesions or diseases affecting the somatosensory system. Understanding its mechanisms and developing effective management strategies are crucial for improving patient outcomes and quality of life. Continued research and refinement of diagnostic and therapeutic approaches will be essential in addressing the challenges posed by neuropathic pain.
Sources and full results
Most relevant research papers on this topic
Neuropathic pain
Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system, with a proposed grading system for clinical and research purposes.
Highly CitedNeuropathic pain
Neuropathic pain management requires a multifaceted approach, with pharmacologic agents like tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors being the strongest options, while nonpharmacologic therapies like acupuncture and massage therapy show mixed evidence.
Highly CitedNeuropathic pain: an updated grading system for research and clinical practice
This paper presents a revised grading system for neuropathic pain, addressing obstacles and improving clinical practice, with a focus on sensory abnormalities and highlighting the need for further research.
Systematic Review
Rigorous JournalHighly CitedNeuropathic Pain
Neurological pain is difficult to treat, impairs quality of life, and has significant societal costs, but cost-effective therapies like tricyclic antidepressants may improve patients' quality of life and reduce costs.
Rigorous JournalHighly CitedNeuropathic pain: From mechanisms to treatment.
Neuropathic pain is caused by structural changes and molecular signaling in the somatosensory nervous system, with potential treatments focusing on ion channels, immune cells, glial-derived mediators, and epigenetic regulation.
Highly CitedNeuropathic pain in the general population: A systematic review of epidemiological studies
Neuropathic pain prevalence in the general population is likely between 6.9% and 10%, with varying incidence and prevalence rates across different conditions.
Systematic Review
Very Rigorous JournalHighly CitedNeuropathic Pain
Diagnosing neuropathic pain accurately is crucial for effective treatment, with calcium-channel modulators, tricyclic antidepressants, and serotonin-noradrenal reuptake inhibitors being first-line options.
Highly CitedNeuropathic Pain in Acute and Subacute Neuropathies: A Systematic Review.
Neuropathic pain is a common symptom in patients with acute/subacute peripheral neuropathies, with a 48.7% overall incidence.
Systematic ReviewNeuropathic pain: mechanisms and their clinical implications
Neuropathic pain develops after nerve injury and is more refractory to conventional analgesics, with high comorbidity rates for chronic pain, sleep disorders, and psychological conditions.
Very Rigorous JournalHighly CitedNeuropathic pain: a maladaptive response of the nervous system to damage.
Neuropathic pain is a maladaptive response to damage to the somatosensory nervous system, influenced by genetic polymorphisms, gender, and age, and requires a disease-modifying strategy to prevent maladaptive plasticity and reduce intrinsic risk.
Highly Cited