Advances in Neuropathic Pain Diagnosis, Mechanisms, and Treatment Recommendations

Arch Neurol. 2003;60:1524-1534.
Robert H. Dworkin, PhD; Miroslav Backonja, MD; Michael C. Rowbotham, MD; Robert R. Allen, MD; Charles R. Argoff, MD; Gary J. Bennett, PhD; M. Catherine Bushnell, PhD; John T. Farrar, MD; Bradley S. Galer, MD; Jennifer A. Haythornthwaite, PhD; David J. Hewitt, MD; John D. Loeser, MD; Mitchell B. Max, MD; Mario Saltarelli, MD, PhD; Kenneth E. Schmader, MD; Christoph Stein, MD; David Thompson, PhD; Dennis C. Turk, PhD; Mark S. Wallace, MD; Linda R. Watkins, PhD; Sharon M. Weinstein, MD

ABSTRACT
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. An evidence-based treatment approach is becoming feasible as the number of published randomized controlled trials continues to grow steadily. In this article, we discuss the diagnosis and assessment of neuropathic pain and survey recent research on pathophysiologic mechanisms. Evidence-based treatment recommendations for the pharmacologic management of chronic neuropathic pain are presented that take into account clinical effectiveness, adverse effects, influence on quality of life, and cost.

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