Chronic Neuropathic Pain- Pharmacist
Despite the availability of new drug therapies, neuropathic pain (NP) continues to pose challenges to patients and practitioners alike. It is often chronic in nature and, in a substantial number of patients, is not relieved by medication. Consequences include diminished mobility and function, lack of sleep, depressed mood, and impaired relationships with family and friends. The full medical and societal burden of NP isn’t clear; however, medical costs are estimated to be 3 times higher than those of patients without NP. The loss of patients’ and/or caregivers' ability to work and the need for additional assistance with tasks of daily living are major societal costs. The prevalence of NP is unknown; estimates place it as low as 1% and as high as 10% in the general population. NP is most commonly seen in patients with diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), radiculopathies (e.g., spinal nerve compression that causes pain in the legs or arms), and nerve trauma. The mainstay of treatment for most types of NP consists of antidepressants, anticonvulsants, topical anesthetics, and opioid analgesics. Only a handful, however, have been FDA approved: gabapentin (Neurontin®, Gralise®), lidocaine 5% patch (Lidoderm®), and capsaicin 8% patch (Qutenza®) for PHN; duloxetine (Cymbalta®) and extended-release tapentadol (Nucynta® ER) for DPN; and pregabalin (Lyrica®) for PHN and DPN. In order to achieve clinically meaningful pain relief, patients commonly require more than one type of medication. Treatment is often complicated by coexisting health conditions, and current guidelines recommend a highly individualized approach to management. Community practitioners can play a key role in helping patients optimize drug therapy and minimize the consequences of NP. This issue briefly reviews NP and the medications recommended for treatment, with a focus on the treatment of DPN and PHN, the most thoroughly studied types of NP.