Advances in Neuropathic Pain

[Guest guest]

From Archives of Neurology

Vol. 60 No. 11, November 2003

Advances in Neuropathic Pain - Diagnosis, Mechanisms, and Treatment

Recommendations

H. Dworkin, PhD; Miroslav Backonja, MD; C. Rowbotham, MD;

R. , MD; R. Argoff, MD; J. , PhD; M.

Bushnell, PhD; T. Farrar, MD; Bradley S. Galer, MD;

A. Haythornthwaite, PhD; J. Hewitt, MD; D. Loeser,

MD; B. Max, MD; Saltarelli, MD, PhD; E. Schmader,

MD; Christoph Stein, MD; , PhD; Dennis C. Turk, PhD; Mark

S. Wallace, MD; R. Watkins, PhD; Sharon M. Weinstein, MD

Arch Neurol. 2003;60:1524-1534.

Chronic neuropathic pain, caused by lesions in the peripheral or central

nervous system, comes in many forms. We describe current approaches to

the diagnosis and assessment of neuropathic pain and discuss the results

of recent research on its pathophysiologic mechanisms. Randomized

controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid

analgesics, tramadol hydrochloride, and tricyclic antidepressants

provide an evidence-based approach to the treatment of neuropathic pain,

and specific recommendations are presented for use of these medications.

Continued progress in basic and clinical research on the

pathophysiologic mechanisms of neuropathic pain may make it possible to

predict effective treatments for individual patients by Application of a

pain mechanism–based approach.

From the Department of Anesthesiology, University of Rochester,

Rochester, NY (Dr Dworkin); Department of Neurology, University of

Wisconsin, Madison (Dr Backonja); Department of Neurology, University of

California, San Francisco (Dr Rowbotham); AstraZeneca, Wilmington, Del

(Dr ); Department of Neurology, North Shore University Hospital,

Manhasset, NY (Dr Argoff); Department of Anesthesiology, McGill

University, Montreal, Quebec (Drs and Bushnell); Department of

Neurology, University of Pennsylvania, Philadelphia (Dr Farrar); Endo

Pharmaceuticals, Chadds Ford, Pa (Dr Galer); Department of Psychiatry,

s Hopkins University, Baltimore, Md (Dr Haythornthwaite);

Ortho-McNeil Pharmaceutical, Raritan, NJ (Dr Hewitt); Departments of

Neurosurgery (Dr Loeser) and Anesthesiology (Dr Turk), University of

Washington, Seattle; Pain and Neurosensory Mechanisms Branch, National

Institute of Dental and Craniofacial Research, Department of Health and

Human Services, Bethesda, Md (Dr Max); Pfizer, Groton, Conn (Dr

Saltarelli); Department of Medicine and Geriatric Research, Education,

and Clinical Center, Duke University and Durham VA Medical Centers,

Durham, NC (Dr Schmader); Department of Anesthesiology, Freie

Universität Berlin, Berlin, Germany (Dr Stein); Innovus Research Inc,

Medford, Mass (Dr ); Department of Anesthesiology, University of

California, San Diego (Dr Wallace); Department of Psychology, University

of Colorado, Boulder (Dr Watkins); and Department of Anesthesiology,

University of Utah, Salt Lake City (Dr Weinstein).