Pharmacological Treatment of Neuropathic Pain

Neuropathic pain is a result of a somatosensory lesion or disease process, either centrally or peripherally. Prevalence is estimated to be in the millions and high as 8% in the general population. Neuropathic pain is often associated with depression, sleep disturbances, compromised physical and emotional functionality, and reduced productivity. Pharmacotherapy is a key component of a multidisciplinary approach to the management of neuropathic pain and is a treatment limited by analgesic efficacy and dose-related side effects. First-line medications for neuropathic pain include tricyclic antidepressants (TCAs), serotonin-noradrenaline reuptake inhibitors (SNRIs), calcium channel alpha2delta-1 ligands (gabapentin and pregabalin), topical lidocaine (lidocaine patch 5%), and topical capsaicin (capsaicin 8% patch). Tramadol is generally considered second-line medication. Sources for this chapter have come from randomized control trials, systematic reviews, meta-analysis, and the IASP NeuPSIG guidelines for the treatment of neuropathic pain.