Novedades en el tratamiento del dolor neuropático

Abstract

Neuropathic pain syndromes are a challenge for professionals working in the field of pain. Although major advances have been made in both diagnostic and analgesic treatment in recent years, satisfactory pain relief is achieved in less than 50% of patients, despite well-indicated treatment. The prevalence in the population is about 6-8% and the distress produced by pain is so intense that it leads to a loss of quality of life and significant functional limitation. The possibility of etiopathological treatment is greatly complicated by the enormous physiopathological complexity of pain, the various mechanisms underlying the various symptoms, both spontaneous and evoked, and the co-occurrence of several mechanisms in the same patient. Diagnosis of neuropathic pain is aided by the patients’ symptoms and questionnaires such as the Neuropathic Pain Diagnostic Questionnaire (DN4), a fairly accurate tool to measure neuropathic pain. Another problem in neuropathic pain is when, how and with what this type of pain should be treated. There are numerous publications on the topic. The treatment of neuropathic pain is itself multidisciplinary, given the comorbidity, the frequency of advanced age in these patients, and the anxiety and depression caused by pain. There is a wide diversity of techniques, types of treatment, combinations, and drug dosages. We review consensus treatments, and emphasize the emerging treatments that represent future therapeutic options: capsaicin and lidocaine patches, cannabinoids and botulinum toxin.