Pharmacological treatment of neuropathic pain

Neuropathic pain results from injury to or dysfunction of the central or peripheral nervous ystem. Diabetic peripheral neuropathy, post-herpetic neuralgia, and trigeminal neuralgia are among the most common types of neuropathic pain. Patients with these types of pain usually suffer from localized symptoms such as constant or intermittent paresthesia, tingling, burning sensation or spontaneous pain. Neuropathic pain is an unpleasant sensation and experience that could adversely affect the quality of life of patients.They often responds to treatment with difficulty and based on the current treatments, only 40 to 60% of patients with neuropathic pain achieve partial relief. Antidepressants (tricyclics and serotoninnorepinephrinereuptake inhibitors), ligand of calcium channel α2-δ subunits (gabapentin and pregabalin) and topical lidocaine have been considered as the first-line therapy for neuropathic pain. Opioid analgrsics and tramadol are generally recommended as the secondline therapy. Other agents such as antiepileptics (e.g.carbamazepine), antagonists of N-Methyl-D-aspartate receptor (e.g. memantine, dextromethorpham), and topical capsaicin have been mainly classified as the third-line treatment for neuropathic pain.Due to the importance of neuropathic pain, reviewing its novel nonpharmacological and pharmacological modalities seems necessary.