Neuropathic pain, caused by a range of lesions and diseases of the somatosensory system, can be particularly problematic to diagnose and treat. It is a common disorder, causing significant personal and societal burden. Diagnosis is mainly based on history and clinical examination but it can often go unrecognised. Treatment modalities include pharmacological and non-pharmacological therapies and a shared plan should be agreed with patients in order to maximise positive outcomes. This article aims to improve understanding of neuropathic pain, describe common presentations seen in primary care, and outline recommended treatments.
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References
1.
BinderARogersPHansG, et al. (2016) Impact of topical 5% lidocaine-medicated plasters on sleep and quality of life in patients with postherpetic neuralgia. Pain Management6(3): 229–239. DOI: 10.2217/pmt-2015-0010.
2.
BouhassiraDAttalNAlchaarH, et al. (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain114(1): 29–36. DOI: 10.1016/j.pain.2004.12.010.
3.
CallaghanBPriceRFeldmanE (2015) Distal symmetric polyneuropathy: A review. Journal of the American Medical Association314(20): 2172–2181. DOI: 10.1001/jama.2015.13611.
DosenovicSKadicAMiljanovicM, et al. (2017) Interventions for neuropathic pain. Anesthesia & Analgesia125(2): 643–652. DOI: 10.1213/ANE.0000000000001998.
6.
FinnerupNAttalNHaroutounianS, et al. (2015) Pharmacotherapy for neuropathic pain in adults: A systematic review, meta-analysis and updated NeuPSIG recommendations. The Lancet Neurology14(2): 162–173. DOI: 10.1016/S1474-4422(14)70251-0.
7.
FinnerupNKunerRJensenT (2021) Neuropathic pain: From mechanisms to treatment. Physiological Reviews101(1): 259–301. DOI: 10.1152/physrev.00045.2019.
8.
GeurtsJWillemsPLockwoodC, et al. (2016) Patient expectations for management of chronic non-cancer pain: A systematic review. Health Expectations20(6): 1201–1217. DOI: 10.1111/hex.12527.
9.
HaanpääMAttalNBackonjaM, et al. (2011) NeuPSIG guidelines on neuropathic pain assessment. Pain152(1): 14–27. DOI: 10.1016/j.pain.2010.07.031.
10.
HaefeliMElferingA (2006) Pain assessment. European Spine Journal15(S1): S17–S24. DOI: 10.1007/s00586-005-1044-x.
11.
HicksCvon BaeyerCSpaffordP, et al. (2001) The faces pain scale – revised: Toward a common metric in pediatric pain measurement. Pain93(2): 173–183. DOI: 10.1016/S0304-3959(01)00314-1.
Mucke M, Philips T, Radbruch L, et al. (2018) Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews 3: art. no.: CD012182. DOI: 10.1002/14651858.CD012182.pub2.
19.
NICE (2020) Guidance CG173: Neuropathic pain in adults: Pharmacological management in non-specialist settings. Available at: www.nice.org.uk/guidance/cg173 (accessed 19 November 2021).
20.
OaklanderANolanoM (2019) Scientific advances in and clinical approaches to small-fiber polyneuropathy. Journal of the American Medical Association Neurology76(10): 1240–1251. DOI: 10.1001/jamaneurol.2019.2917.
PriceCWilliamsASmithB, et al. (2019) The National Pain Audit for specialist pain services in England and Wales 2010–2014. British Journal of Pain13(3): 185–193. DOI: 10.1177/2049463718814277.
ScholzJFinnerupNAttalN, et al. (2019) The IASP classification of chronic pain for ICD-11: Chronic neuropathic pain. Pain160(1): 53–59. DOI: 10.1097/j.pain.0000000000001365.
26.
SloanGAlamUSelvarajahD, et al.The treatment of painful diabetic neuropathy. Current Diabetes Reviews.2021. Epub ahead of print 6 July 2021. DOI: 10.2174/1573399817666210707112413.
27.
TölleTXuXSadoskyA (2006) Painful diabetic neuropathy: A cross-sectional survey of health state impairment and treatment patterns. Journal of Diabetes and its Complications20(1): 26–33. DOI: 10.1016/j.jdiacomp.2005.09.007.
28.
Toth C and Moulin D (2013) Neuropathic Pain. Cambridge: Cambridge University Press.
29.
Van HeckeOAustinSKhanR, et al. (2014) Neuropathic pain in the general population: A systematic review of epidemiological studies. Pain155(4): 654–662. DOI: 10.1016/j.pain.2013.11.013.
30.
WilliamsAFisherEHearnL, et al. (2020) Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews11. : art. no.: CD007407. DOI: 10.1002/14651858.CD007407.pub4.
