Pharmacotherapy for Neuropathic Pain: A Review

Diego Fornasari
Pain and Therapy 2017, 6 (Suppl 1): 25-33

Neuropathic pain, comprising a range of heterogeneous conditions, is often severe and difficult to manage, and this may result in a chronic condition that negatively affects the overall functioning and quality of life in patients. The pharmacotherapy of neuropathic pain is challenging and for many patients effective treatment is lacking; therefore, evidence-based recommendations are essential. Currently, there is general agreement on which drugs are appropriate for the first-line treatment of neuropathic pain, whereas debate continues regarding second- and third-line treatments. First-line drugs for neuropathic pain include antidepressants (tricyclic antidepressants and serotonin-noradrenaline reuptake inhibitors) and anticonvulsants acting at calcium channels (pregabalin and gabapentin). Second- and third-line drugs for neuropathic pain include topical lidocaine and opioids. Although efficacious in the treatment of neuropathic pain, opioids are not considered to be a first choice because of adverse drug reactions and, more recently, because of concerns about abuse, diversion, and addiction. A clear understanding of the mechanism of action of currently available drugs is an essential step towards an effective clinical approach that aims to tailor therapies both to the specific neuropathic disease and to the needs of an individual patient. This review provides an overview of current drugs available for the treatment of neuropathic pain with an emphasis on their mechanism of action.

FUNDING: Pfizer, Italy.

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Jeff Smith

Having been on opiates for 2 decades now ( I am a disabled veteran ₩ 2 purple hearts I can say without a doubt I would be bed-bound without them. The drugs that gave the best results was Demeral (meperidine) this drug was available prescription only for overall 50 years. The FDA pulled it because a few patients had siezures. It is situations like this that cause pain patients to commit suicide in hospital parking lots. It truly feels as if doctors don't care about treating pain anymore making us live with ZERO quality of life. Some people do need these opiates to function in life, please do not let those who think meds are evil destroyed what life we have left. I left one of my legs on the battlefield, don't let me leave my mind here


Romeo Mariano

Good review


Casandra Rodgers

Good overview, but it would be helpful to have data included about the efficacy rates of the drugs - what percentage of patients received >50% pain relief, data from systematic reviews, etc. But I appreciate the explanations of the proposed mechanisms of action.


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