Opioids and Chronic Neuropathic Pain

Chronic neuropathic pain is a serious problem resulting from injury to the central or peripheral nervous system; it affects more than 2 million Americans. Despite advances in our understanding of the pathophysiology and molecular biology of neuropathic pain, its clinical management remains disappointing and controversial. Antidepressants and anticonvulsants have been demonstrated to provide analgesia but are effective in less than half of patients half the time.1 Opioid treatment of neuropathic pain is often discouraged, because of concern about ineffectiveness, the potential for the development of tolerance, the risk of addiction, and limiting side effects.2 In this issue of the Journal, . . .