Semin Neurol 2016; 36(05): 462-468
DOI: 10.1055/s-0036-1584950
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neuropathic Pain

Janne Gierthmühlen
1   Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Ralf Baron
1   Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
23 September 2016 (online)

Abstract

Diagnosing neuropathic pain and distinguishing it from nociceptive pain can be challenging, but is essential because both forms of pain require different treatment strategies. The diagnosis of neuropathic pain is primarily based on clinical findings. Therefore, a careful, focused history and an examination of the signs characteristic of neuropathic pain are crucial. Imaging techniques and electrophysiological examinations, as well as punch skin biopsy can support the clinical diagnosis. Ideally, treatment should be individualized using a mechanism-based approach. However, current treatments are usually dispensed without precision, and calcium-channel-acting modulators (pregabalin, gabapentin), tricyclic antidepressants, and serotonin-noradrenalin reuptake inhibitors (duloxetine, venlafaxine) represent first-line treatment options for neuropathic pain. Although neurostimulation techniques for the treatment of refractory chronic pain have become more important, most evidence of long-term effectiveness and safety is still limited, which strengthens the need for larger randomized controlled trials before final recommendations can be made.