Neuropathic pain: current definition and review of drug treatment

Neuropathic pain is relatively common and often poorly treated.Management options include tricyclic antidepressants or serotonin and noradrenaline reuptake inhibitors in the first instance, followed by pregabalin or gabapentin.Tramadol or topical lidocaine (lignocaine) could be considered as second line.Stronger opioids have been relegated to third line.It is important to remember that opioids and gabapentinoids have abuse potential.Fibromyalgia and chronic low back pain without radiculopathy do not meet the current criteria for the definition of neuropathic pain. Drugs for neuropathic painThe IASP's Neuropathic Pain Special Interest Group (NeuPSIG) has recently undertaken a systematic review of medicines for neuropathic pain (Table).4 Fibromyalgia, atypical facial pain, complex regional pain syndrome and chronic low back pain without radiculopathy were not included in the review as they do not meet the current criteria for the definition of neuropathic pain.