Advances in the Diagnosis and Treatment of Neuropathic Pain:The important Role of Physical Medicine and Rehabilitation Approaches

摘要

Neuropathic pain (NP) occurs due to an aberrant somatosensory process in the peripheral or central nervous system due to a complex pathologic distortion of normal nociception that may occur at multiple levels. NP is one of the important causes of pain in rehabilitation medicine patients such amputees, spinal cord injuries, stroke or peripheral neuropathies. Improved understanding and management of NP is therefore clearly desirable in the rehabilitation medicine practice. Management of NP is still challenging and anecdotal to the present moment. The goal of contemporary management remains control of pain and improvement of function and health-related quality of life with avoidance, if possible, of therapeutic toxicity. A multimodality therapeutic approach aiming at multiple levels of the peripheral and central nervous system is ideal. Tricyclic antidepressants (TCAs), anticonvulsants, opioids, and topical agents are usually associated with non-invasive peripheral neurostimulatory approaches including TENS, percutaneous electrical nerve stimulation and acupuncture. Psychological and intensive rehabilitative interventions are also used. Patients with severe chronic NP who failed to respond to such therapeutic modalities are usually scheduled for invasive neurostimulatory, including dorsal column and deep brain stimulation or neurodestructive procedures.