Regional Techniques and Interventions for Intractable Neuropathic Pain

The International Association for the Study of Pain defines neuropathic pain as “pain caused by a lesion or disease of the somatosensory nervous system.” The injury or disease may occur in the peripheral or central nervous system giving rise to known painful conditions such as postherpetic neuralgia, painful diabetic neuropathy, trigeminal neuralgia, post-amputation pain, pain after spinal cord injury, post-stroke pain or complex regional syndrome. These painful conditions are challenging to treat. Even though pharmacotherapy is the cornerstone in the initial treatment of neuropathic pain, many patients do not respond optimally or they may suffer intolerable side effects from the medications. These patients are often disabled from the severe pain and have poor quality of life, experiencing anxiety, depression and sleep problems. Patients dissatisfied with their pain relief often strain the healthcare system with frequent visits. These patients may benefit from a multimodal approach to pain management using interventions that specifically target neuropathic pain, such as sympathetic blocks, infusion therapy or neuromodulation.