Page 34 - GALENIKA MEDICAL JOURNAL

Abstract

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. According
to the International Association for the Study of Pain (IASP), neuropathic pain is pain caused by a lesion or disease of the
somatosensory nervous system. The prevalence of neuropathic pain in the general population ranges from 6.9 to 10%.
According to the 2008 grading system, neuropathic pain is divided into three classes: possible, probable, and definite
neuropathic pain. Concerning the clinical presentation, neuropathic pain is divided into spontaneous and evoked. Chronic
neuropathic pain is persistent or recurrent pain lasting at least three months. Depending on whether the somatosensory
part of the central or peripheral nervous system is affected, it is divided into two large groups: central and peripheral
neuropathic pain. The group of peripheral neuropathic pain includes: trigeminal neuralgia, phantom limb, painful
radiculopathy, postherpetic neuralgia, painful polyneuropathy, and pain caused by injury to peripheral nerves. Central
neuropathic pain is pain caused by a lesion or disease of the central somatosensory nervous system. The most common
conditions that lead to central neuropathic pain are: spinal cord injuries, brain injuries, stroke and multiple sclerosis. The
first line of treatment for neuropathic pain is tricyclic antidepressants (amitriptyline), antiepileptics (pregabalin, gabapentin)
and selective serotonin reuptake inhibitors (venlafaxine and duloxetine). The second line of therapy for neuropathic pain
includes opioid analgesics: tramadol/tramadol ER and tapentadol. Morphine and oxycodone are recommended as a third
treatment option. In addition to pharmacological, non-pharmacological treatment methods are also used, including:
blockade of peripheral nerves, epidural application of corticosteroids, radiofrequency neuroablation, peripheral and central
neurostimulation, as well as various methods of physical therapy.

Keywords: peripheral and central neuropathic pain, definition, classification, treatment

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32 DOI: 10.5937/Galmed2410028A