Via practica 4/2006

Neuropathic pain – patophysiological mechanisms, clinical picture and therapy

Neuropathic pain represent heterogenous conditions with different aetiology , localization of anatomical lesion and patophysiological mechanisms. In this time, no satisfactory and comprehensive classification of neuropathic pain exist. It is generally classified, according to the site of the injury to central and peripheral neuropathic pain. But this division is not so well demarcated because several painful peripheral lesions produce changes in the central nervous system, and some diseases involve the central and peripheral nervous system. The management of neuropathic pain remains a difficult problem despite the great progress both in the understanding patophysiological mechanism and in finding new drugs. It ussually fails to respond to conventional and opioid analgesics or gives relief only at very high doses. The first –line drugs include adjuvants particularly anticonvulsant and antidepressants. Satisfactory management of neuropathic pain involves the combined use of a range of pharmacological and non-pharmacological approaches. This report presents a brief overview of the basic patophysiological mechanisms of neuropathic pain and reviews classification and current therapeutic approaches.

Keywords: neuropathic pain, central and peripheral, patophysiological mechanism, classification, adjuvants, invasive approaches.