Abstract
Neuropathic pain is a result of complex interactions between peripheral and central
mechanisms with multiple potential therapeutic targets. However, the complexity of
these mechanisms and relative youth of translational pain research, which is in its
infancy, have prevented translation of successful basic bench research to human therapy.
Most of the clinically available neuropathic pain treatments are borrowed from other
therapeutic areas, such as antidepressants and antiepileptics, or involve application
of older therapy, such as opioids. Exceptions are ziconotide, tapentadol, and the
high-concentration capsaicin patch. Similar to all other analgesic agents, these provide
only partial pain relief in subsets of patients. The standard of care for patients
with chronic neuropathic pain is multimodal and multidisciplinary. For most patients
to achieve and maintain satisfactory pain relief a combination of therapeutic agents
is necessary, providing the empiric basis for rational polypharmacy, which has become
a standard approach as well.
Keywords
neuropathic pain - somatosensory nervous system - mechanisms of action - analgesia
