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Neuropathic Pain

Neuropathic Pain

The Neuropathic Pain Knowledge Centre is a unique resource containing a wealth of current information in this field of medicine.

The nervous system (central and peripheral) constantly receives and interprets information about the body's surroundings and the body's own functioning, responding by sending out messages to tissues and organs.

The Knowledge Centre addresses the two types of pain: nociceptive and clinical. Nocicpetive pain aims to protect individuals from harm. Clinical pain results from damage or inflammation of a part of the body and consists of both spontaneous pain that may arise with no apparent peripheral stimulus, and from hypersensitivity to peripheral stimuli1 due to peripheral and central sensitisations.

Neuropathic pain is often described as a shooting, stabbing or burning sensation. Estimates suggest that neuropathic pain may affect as much as 3% of the population.

Different types of neuropathic pain exist depending on their origin, details of which can be found in the Knowledge Centre: Painful Diabetic Neuropathy, Herpes Zoster and Post-Herpetic Neuralgia (PHN), HIV Associated-Neuropathy (HIV-AN), Cancer-related Neuropathic Pain, Post-surgical/Post-traumatic Neuropathic Pain.

In the clinic, the diagnosis of neuropathic pain relies on an accurate history and examination and some pain evaluation tools are used.

As Neuropathic pain doesn't respond to conventional therapy with analgesics, the different treatment regimens are antidepressants, anticonvulsants, opioids, topical agents and combination treatment.

To help physicians in the pharmacological management of this condition, recent guidelines are available.

Enter the Neuropathic Pain Knowledge Centre


References:

1. Ji R-R, et al. Central sensitization and LTP: Do pain and memory share similar mechanisms? Trends in Neuroscience 2003;26(12):696–705

Date of preparation: August 2012 PAIN/12/0003/EUd

Recent Drug Updates

Clinical Guidelines

Management of chronic pain

Dec 2013

This guideline provides recommendations based on current evidence for best practice in the..

... assessment and management of adults with chronic non-malignant pain in non-specialist settings. It does not cover: - interventions which are only delivered in secondary care. - treatment of patients with headache - children. While chronic pain occurs in children, some of their treatment options are different to those of adults, and evidence on the paediatric population has not been included in this remit. - underlying conditions. Chronic pain is caused by many underlying conditions. The treatment of these conditions is not the focus of this guideline so the search strategies were restricted to the treatment of chronic pain, not specific conditions.

Neuropathic pain – pharmacological management: The pharmacological management of neuropathic pain in adults in non-specialist settings

Nov 2013

This short clinical guideline aims to improve the care of adults with neuropathic pain by making..

... evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.

Clinical Trials

Improvement After Physiotherapy for Low Back Pain: The Good Responders

18-06-2014

This is an observational study that aims to characterize individual response of patients getting physical therapy for chronic non-specific low back pain.

Participants will be classified based on a questionnaire and motor tests to investigate whether individual improvement after physical therapy may be..

... predicted. These observations may help to decide which should be the preferred treatment offered.

Psychobiological Mechanisms of Placebo and Nocebo Effects in the Treatment of Chronic Back Pain

03-06-2014

Placebo and nocebo responses have mainly been studied in healthy humans for pharmacological rather than psychological interventions. Moreover, only few studies examined patients or tested how previous experience and attitudes affect placebo and nocebo responses. On the psychological level expectancy and classical..

... conditioning have been identified as two primary mechanisms. Both seem to be important with classical conditioning potentially having more long-term effects and expectancy being more important in nocebo effects. There is some initial evidence from the investigators own research that patients may be more prone to these effects and the investigators have also shown that placebo effects may last up to several years after treatment. The investigators therefore examine previous attitudes to pharmacological interventions for chronic pain in patients with chronic back pain and subdivide them into groups with high of low belief in the respective treatment modality. The investigators then apply a pharmacological placebo and study the interaction between the prevailing attitude (implicit and explicit) and the placebo effect with respect to pain perception but also to neurobiological mechanisms using functional magnetic resonance imaging. In addition to expectancy, conditioning of placebo will be examined and the long-term effects of the intervention will be determined.

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