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[Guideline of neuropathic pain treatment and dilemma from neurological point of view].

Abstract
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.
AuthorsChun-Ming Yang, Nan-Cheng Chen, Hsiu-Chu Shen, Chi-Ho Chou, Poh-Shiow Yeh, Huey-Juan Lin, Chia-Yu Chang, Tain-Junn Cheng, Kao-Chang Lin
JournalActa neurologica Taiwanica (Acta Neurol Taiwan) Vol. 21 Issue 3 Pg. 136-44 (Sep 2012) ISSN: 1028-768X [Print] China (Republic : 1949- )
PMID23196735 (Publication Type: English Abstract, Journal Article)
Chemical References
  • Analgesics
Topics
  • Analgesics (therapeutic use)
  • Guidelines as Topic
  • Humans
  • Neuralgia (etiology, therapy)

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