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22 - Treatment of neuropathic pain
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- By Stephan A Schug, School of Medicine and Pharmacology, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Kathryn JD Stannard, School of Medicine and Pharmacology, University of Western Australia, Royal Perth Hospital, Perth, Western Australia
- Robert Fitridge, University of Adelaide, Matthew Thompson, St George's Hospital Medical School, London, UK
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- Book:
- Mechanisms of Vascular Disease
- Published by:
- The University of Adelaide Press
- Published online:
- 05 June 2012
- Print publication:
- 01 June 2011, pp 401-422
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- Chapter
- Export citation
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Summary
INTRODUCTION
Neuropathic pain is defined by The International Association for the Study of pain (IASP) as pain following a primary lesion or dysfunction of the nervous system. It is caused either by peripheral damage with lesions involving peripheral nerves, dorsal root ganglia and the dorsal roots (peripheral neuropathic pain) or by central damage, which may involve injury caused by infarction or trauma of spinal cord or brain (central neuropathic pain).
Neuropathic pain results in persistent pain syndromes that have no biological function, but are difficult to treat and cause great distress to the individual. Neuropathic pain is also referred to as neurogenic pain, deafferentation pain, neuralgia, neuralgic pain and nerve pain.
Neuropathic pain may develop immediately after a nerve injury or after a variable interval. It may be maintained by factors different from the initial cause. It can persist for a long time and is frequently not explained by underlying pathology. Patients are frequently seen by many different specialists and their treatment often fails to resolve the pain. As the pain persists other factors such as environmental, psychological and social stressors become relevant contributors to the overall presentation.
PRINCIPLES OF TREATMENT
Treatment of neuropathic pain is not straightforward. The pain is often refractory to conventional analgesic regimens such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Opioids have only limited efficacy in neuropathic pain as outlined later in this chapter; therefore so called co-analgesics, medications which are not typically used as analgesics, are often the first-line treatment of neuropathic pain.