Local Therapies for Localised Neuropathic Pain

InrroducrionLocalised neuropathic pa in co m mo nly arises d ue to d amage to a perip heral nerve; but can also arise fro m dam age to o r hyperreactivity of nerve plexus, nerve root, o r occas ionally from central pro cesses'.Th is type of pain ca n cause s ignificam negati ve imp act o n q uality of life.Systemic d rugs used 10 rrear Neuro pathic pain , such as a nddep rcssam s. anrico nvulsanrs and o pio id an algesics can also cause sign ificam side elfec ls such as sedation, d rowsiness a nd cog n itive dysfunction that increase d ifficulties for the pati ent ' .This paper w ill add ress local trea rmen r o ptions that are effective fo r locali sed neuropathic pain wh ilst avoidi ng the lo ng-term syste mic side effects of medic atio ns; it sho uld be m enti oned th at the re are well kno wn co mplica tio ns that co uld arise afi er in vasive therapies, but th ese arc m in im ised in the ha nds o f experienced clinicians and by usin g advanced imaging tech niq ues and o ther precautionary measures. Topical rharmacol ogk al AgenuA mitri ptyline and Ga bapenrtn arc well known syste mic drugs used in the ma nagem em of neuropathic pain.H owCVCl, they are also used as topical agents , appare m ly with some success, pa rticularly the use o f gabape m in in vulvo dy nia.Th e mechan isms for ropkal rel ief o f pain seem ro differ from their ce ntral e ffect s, and the mechani sm ofaction is u nknown.l he uses of many agents are limited ro sym parherically medi ated pai n ' a nd rrear men r-restsranr pa in.as they are nOI freely available, although the re a re ongoing st udies lo okin g im o the use o f var ious com binatio ns of d ifferen t agem s to pically, Amir rip tyline crea m has been used in th e managem em o f posrrrau manc neuropath ic pain t, but in srud jes when compa red with 5% lidocaine crea m' and 3.3% d oxepin cream", arn irrip rylin e cream was fo u nd to be less efficacious.H owever, wh en co mbi ned with keram ine cream , topical a mitriptyli ne showed promising results in ne uro pathic pain Slates' a nd a lso in th e ma nagemen t o f refracto ry proctodyn ia".Th e use of th e above com bin ed with Baclofen in a crea m fo rm has bee n show n to be e ffective in chc morhe rapy-Induced perip he ral neurop athy", Topical G abapem in has bee n used in {he man agem em o f localised a nd general ised vulvod ynia'" a nd anecd otall y has been tri ed in ot her neuropathic pain stares.Lidoca ine cream s and EM.LA are also used .especially for mu cous mem branes, but has largely been replaced by 5% lidoca ine plasters o n skin , wh ich is di scussed below.Keramln e is used as a systemic agent in the manageme nt o f neu ropath ic pain , bu t its use as a topical gel has also been explo red ".