Invited Review: An overview of the non-procedural treatment options for peripheral neuropathic pain-Link to article

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The review, authored by Evan R. Zeldin and colleagues, discusses non-procedural treatments for peripheral neuropathic pain, which results from damage to peripheral nerves and affects patients significantly. First-line pharmacologic treatments include gabapentinoids, tricyclic antidepressants (TCAs), and serotonin-norepinephrine reuptake inhibitors (SNRIs), using various mechanisms to dull pain. Gabapentinoids, like gabapentin and pregabalin, are anti-epileptic drugs that inhibit specific calcium channels. TCAs alleviate pain by affecting norepinephrine and serotonin reuptake, with additional opioid receptor activity. SNRIs block serotonin and norepinephrine presynaptic uptake. These medications are selected based on individual side effects, patient conditions, and potential benefits beyond pain management. <br /><br />Topical treatments like capsaicin and lidocaine patches offer alternative options, albeit with weaker recommendations. Capsaicin desensitizes pain receptors, whereas lidocaine blocks nerve fiber depolarization. Mixed evidence surrounds the use of opioids and cannabinoids, the former being generally not recommended due to associated risks, and cannabinoids discouraged due to potential misuse.<br /><br />Therapy-based interventions, including cognitive-behavioral therapy (CBT) and adjunct therapies such as Acceptance and Commitment Therapy (ACT), are instrumental alongside pharmacologic treatments. These psychological approaches focus on managing the cognitive, emotional, and environmental influences on pain.<br /><br />Lifestyle factors play a crucial role as well; modifications may address underlying conditions like diabetes contributing to neuropathic pain. Practices emphasizing nutrition, exercise, stress management, and sleep hygiene can alleviate pain and improve overall health outcomes.<br /><br />Conclusively, the review highlights the multifaceted nature of treating peripheral neuropathic pain, with pharmacologic treatments as the primary, evidence-supported strategy but accentuates the necessity of supplemental therapies and lifestyle changes for comprehensive management.

Keywords

peripheral neuropathic pain

non-procedural treatments

gabapentinoids

tricyclic antidepressants

serotonin-norepinephrine reuptake inhibitors

topical treatments

cognitive-behavioral therapy

lifestyle modifications

pain management

Evan R. Zeldin