Neuropathic pain is a complicated symptomatic disease as
migraine in recent years. Not because the
pain character differed from the nociceptive inflammatory symptoms but because of its complexity of mechanisms. Though peripheral sensitization, ectopic discharge, central sensitization, central re-organization and loss of inhibition play part of roles in mechanisms, however, based on this mechanistic treatment, the outcome still disappointed physicians and patients, exampled as central post-
stroke central
pain (CPSP). The
pain reduction is far less than the expectation from patients and physician's under-treatment frequently occur due to the fear of adverse effects or
off-label use of these anti-
neuropathic pain drugs. Therefore, a multidisciplinary procedure including non-pharmacological management, rehabilitation program, careful explanation, stepwise
pain reduction, daily diary record, and tailored individual planning for medications are helpful in treating this kind of sufferers. Pharmacological treatment is the mainstream in post-herpetic
neuralgia (PHN), diabetic peripheral
neuropathic pain (DPNP), central post-
stroke pain (CPSP),
trigeminal neuralgia (TN),
complex regional pain syndrome (CRPS),
cancer pain, failed back syndrome etc, while
polypharmacy is still the major prescriptions facing such kind of miserable patients. The
tricyclic antidepressants (TCA),
gamma- aminobutyric acid (
GABA),
voltage-dependent calcium channel blockers, selective non-
epinephrine reuptake inhibitor (
SNRI),
opioid or
morphine etc, are still evidence-based medicines (EBM) but with different outcome for individuals. Acupuncture is to some extend effective in Taiwanese people with perceived evidence or placebo. The Taiwan guidance for total
pain management and review of EBM in treating
neuropathic pain from neurological point of view will be introduced in this manuscript.