Introduction. Neuropathic pain, or pain associated with disease or injury to
the peripheral or central nervous system, is a common symptom of a
heterogeneous group of conditions, including diabetic neuropathy, trigeminal
neuralgia, postherpetic neuralgia and spinal cord injury. Chronic neuropathic
pain should not be thought of as a symptom. It should truly be thought of as
a disease with a very complicated pathophysiology. Pathophysiology. The
mechanisms involved in neuropathic pain are complex and involve both
peripheral and central pathophysiologic phenomenon. The underlying
dysfunction may involve deafferentation within the peripheral nervous system
(e.g. neuropathy), deafferentation within the central nervous system (e.g.
post-thalamic stroke) or an imbalance between the two (e.g. phantom limb
pain). Clinical characteristics. Neuropathic pain is non-nociceptive, in
contrast to acute nociceptive pain, and it can be described as ?burning?,
?electric?, ?tingling?, and ?shooting? in nature. Treatment. Rational
polypharmacy is often necessary and actually it is almost always the rule. It
would be an exception if a patient was completely satisfied with his
treatment. Treatment goals should include understanding that our patients may
need to be titrated and managed with more than one agent and one type of
treatment. There should be the balance of safety, efficacy, and tolerability.
Conclusion. There are many new agents and new applications of the existing
agents being currently studied which will most certainly lead to even more
improved ways of managing this very complicated set of disorders.