Neuropathic Pain

Book excerpt: Neuropathic pain is one of the most common, most debilitating, most costly, and most difficult to treat categories of chronic pain conditions that are characterized by a lesion or disease of the somatosensory nervous system. Managing neuropathic pain is challenging and requires skillful assessment and comprehensive and integrated treatment strategies that are mechanism-guided, evidence-based, and individualized. However, these critical and integral elements are very fragmented in the current literature. The mechanistic understanding of neuropathic pain is typically found in basic research articles. Clinical research evidence is presented in forms of clinical trials with emphasis on minimizing biases such as those from patient selection and assessment. Individualized considerations for each patient are usually presented in case reports and problem-based learning discussions. This book overcomes these barriers and integrates all the critical elements around individual patient care into a coherent management strategy that is practical and applicable to daily clinical practice. Rather than compiling what have been published in the literature, this work emphasizes on identifying and highlighting the key points or findings that guide decision-making in clinical practice. It integrates the key points around a typical case scenario that not only represents the core of the diagnostic and therapeutic processes but also allows introduction and differentiation of painful conditions that bare similarities with the case in hand. The overarching goal is to improve clinical outcomes through better understanding of the mechanisms, more accurate diagnosis, and wiser and more comprehensive treatment strategies.