Contemporary management of neuropathic pain for the primary care physician.

Full Abstract

Neuropathic pain (NP), caused by a primary lesion or dysfunction in the nervous system, affects approximately 4 million people in the United States each year. It is associated with many diseases, including diabetic peripheral neuropathy, postherpetic neuralgia, human immunodeficiency virus-related disorders, and chronic radiculopathy. Major pathophysiological mechanisms include peripheral sensitization, sympathetic activation, disinhibition, and central sensitization. Unlike most acute pain conditions, NP is extremely difficult to treat successfully with conventional analgesics. This article introduces a contemporary management approach, that is, one that incorporates nonpharmacological, pharmacological, and interventional strategies. Some nonpharmacological management strategies include patient education, physical rehabilitation, psychological techniques, and complementary medicine. Pharmacological strategies include the use of first-line agents that have been supported by randomized controlled trials. Finally, referral to a pain specialist may be indicated for additional assessment, interventional techniques, and rehabilitation. Integrating a comprehensive approach to NP gives the primary care physician and patient the greatest chance for success.

Author information

Author/s: Chen, Hsiupei (H); Lamer, Tim J (TJ); Rho, Richard H (RH); Marshall, Kenneth A (KA); Sitzman, B Todd (BT); Ghazi, Salim M (SM); Brewer, Randall P (RP);

Affiliation: Division of Pain Medicine, Duke University Medical Center, Durham, NC, USA. chen0025(-atsign-)mc.duke.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Review

Journal: Mayo Clinic proceedings. Mayo Clinic (Mayo Clin Proc), published in United States. (Language: eng)

Reference: 2004-Dec; vol 79 (issue 12) : pp 1533-45

Dates: Created 2004/12/14; Completed 2005/01/06; Revised 2007/11/15;

PMID: 15595338, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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