Rabia Malik, Muhib Alam Khan.
Management of neuropathic pain.
Med Today Jan ;4(1):14-8.

Neuropathic pain is a condition in which pain persists even after the removal of the noxious stimulus. The common etiologies are diabetic polyneuropathy, post-herpetic neuralgia, radiculopathy, cancer pain and HIV neuropathy. The management of neuropathic pain starts with the history and physical examination. This helps in differentiating between nociceptive and neuropathic pain. Electromyography and Nerve Conduction (EMG-NC) studies are also used to establish the etiology. The management differs between localized and generalized etiologies. Localized pain such as post-herpetic neuralgia can be treated with topical lidocaine whereas the generalized neuropathic pain in diabetic polyneuropathy requires systemic drugs. Pharmacological therapy involves medications such as antidepressants, antiepileptics and opioids. Nonpharmacological therapy involves use of physiotherapy, Transcutaneous Electrical Nerve Stimulation (TENS) and psychological therapy. Patients who do not respond to these measures are referred to specialized pain clinics. Pain interventionists use nerve blocks, epidural blocks and spinal cord stimulation to decrease pain intensity. Neuropathic pain is a complex problem presenting to family practice and established algorithms will help in accurate diagnosis and effective management. This will also help in establishing an effective referral system to the pain clinics.

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