Neuropathic pain (NP) is pain caused by injury or disease of the somatosensory system, a syndrome caused by many different diseases and damages, and can be divided into peripheral neuropathic pain (pNP) and central nervous system pathological pain according to the site of damage to the sensory nervous system.
Clinically more common pNP: such as painful diabetic peripheral neuropathy (PDPN), postherpetic neuralgia (PHN). Commonly used treatment drugs for pNP are mainly anticonvulsants, antidepressants, tramadol, opioids, and topical treatment drugs.
1 Peripheral neuropathic pain (pNP)
First-line agents recommended by the 2010 IASP and the latest edition of guidelines from the European Union of Neurological Societies (EFNS) for the treatment of neuropathic pain include calcium channel modulators (e.g., pregabalin, gabapentin), tricyclic antidepressants (TCAs), and serotonin and norepinephrine reuptake inhibitors (SNRIs).
In addition, topical lidocaine can be used as a first-line treatment for postherpetic neuralgia (PHN) and carbamazepine can be used as a first-line agent for trigeminal neuralgia. Second-line drugs include opioids and tramadol.
Table 1. Medication and precautions for peripheral neuropathic pain
2 Postherpetic neuralgia (PHN)
Postherpetic neuralgia (PHN) is a common pNP that may be developed by peripheral sensitization, central sensitization, inflammatory responses, nerve deaeration, sympathetic dysfunction, and neuroplasticity as the basis for PHN production.
Table 2. Guidelines for the treatment of postherpetic neuralgia and consensus recommendations
3 Painful diabetic peripheral neuropathy
Painful diabetic peripheral neuropathy (PDPN) is the most common chronic complication of diabetes mellitus, a common pNP, the pathogenesis of which is related to peripheral sensitization, central sensitization, failure of the downward inhibition system, and changes in ion channels.
Table 3. Guidelines and consensus recommendations for the treatment of peripheral neuropathy in painful diabetes
4 Other peripheral neuropathic pain treatment
Postoperative or post-traumatic NP:
Pregabalin, gabapentin, 5% lidocaine patches and gels are recommended for the first line, TCAs (amitriptyline), and opioids are recommended for the second or third line.
Cranial neuralgia:
The first line recommends carbamazepine and oxcarbazepine, and the second or third line recommends pregabalin and gabapentin;
Chemotherapy-induced peripheral neuropathy (CIPN):
A common treatment-related complication, pregabalin, gabapentin, and duloxetine are recommended on the first line, and opioids are recommended on the second or third line.
Resources:
1. Chinese expert consensus on the diagnosis and treatment of peripheral neuropathic pain[J]. Chinese Journal of Pain Medicine,2020,26(5):321-325.
2. Expert consensus on the diagnosis and treatment of diabetic peripheral neuropathic pain[J]. Chinese Journal of Pain Medicine,2018,24(8):561-565.
3. Chinese expert consensus on the diagnosis and treatment of postherpetic neuralgia[J]. Chinese Journal of Pain Medicine,2016,22(3):163-164.
4. Expert consensus on neuropathic pain diagnosis and treatment[J]. Chinese Journal of Pain Medicine,2013,19(12):705-708.
5. Expert consensus on the whole process of management of shingles-related pain[J]. Chinese Journal of Dermatology,2021,54(10):841-845.
6. Expert consensus on shingles in China[J]. Chin J Dermatology,2018,51(6):403-406.
7. Fu Zhijian et al. Can postherpetic neuralgia be completely cured: A three-step treatment regimen for postherpetic neuralgia[J]. Chinese Journal of Pain Science,2021,17(2):115-117.
8. Guidelines for Postoperative Pain Management for Clinical Pharmacists (Guangdong Pharmaceutical Association, January 31, 2019).
Expert consensus on drug treatment of chronic musculoskeletal pain (2018)[J]. Chinese Journal of Pain Medicine,2018,24(12):881-886.
Expert consensus on chronic pain management in the musculoskeletal system[J]. Chinese Journal of Bone and Joint Surgery,2020,13(1):9-15.
11. Chinese Expert Consensus on Chronic Musculoskeletal Pain Management in Elderly Patients (2019)[J]. Chinese Journal of Geriatrics,2019,38(5):500-504.
Expert consensus on the perioperative application of non-opioid analgesics in adults[J]. International Journal of Anesthesiology and Resuscitation,2019,40(1):1-6.
13. Expert consensus on the diagnosis and treatment of opioid adverse reactions in traditional Chinese medicine[J]. Chinese Journal of Oncology,2019,46(7):321-323.
14. Beijing Cancer Pain Management Norms (2017 Edition)[J]. Chinese Journal of Pain Medicine,2017,23(12):881-889.
15. Shanghai Expert Consensus on Cancer Pain Diagnosis and Treatment (2017 Edition)[J]. China Oncology,2017,27(4):312-317.
Expert consensus on adverse reactions of analgesic drugs[J]. Electronic Journal of Tumor Metabolism and Nutrition,2021,8(2):139-141.
17. Expert consensus on pain management after adult surgery[J]. Journal of Clinical Anesthesiology,2017,33(9):911-917.
18. Guidelines for the prevention and treatment of type 2 diabetes in China (2020 edition)[J]. Chinese Journal of Diabetes,2021,13(4):315-376.
19. Guidelines for the Diagnosis and Treatment of Diabetes in the Elderly in China (2021 Edition)[J]. Chinese Journal of Diabetes,2021,13(1):14-36.
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