[Challenges in the treatment of neuropathic pain]

Neuropathic pain is a difficult to diagnose condition. The definition changes have tried to clarify the confusing consequences about including the word "dysfunction". However, diagnosing problems are not only a definition issue, but also a technical problem. Heat-pulsing-lasers are a very interesting tool to diagnose neuropathic pain, but, at the moment, they are not available in many clinical centers. Because there was not a precise diagnostic tool widely available, a gradation system was developed. It classifies neuropathic pain into three categories: definite, probable or possible neuropathic pain. Neuropathic pain can be produced by different lesions or diseases, either in the central nervous system (CNS) or in the peripheral nervous system (PNS), and it uses to appear in a context of some comorbidities, so it is important to determine the impact over the quality of life and also over the economy (chronic treatment and sick leaves). Some studies have tried to estimate these consequences. Pregabalin has provided throughout different studies important health system cost reductions and also reduced sick leaves. Nevertheless, because only pharmacological-based therapies cannot control disease symptoms and there are still diagnostic problems, it is important to perform a multidisciplinary approach to neuropathic pain to balance these issues. Thus, some studies have investigated different non-pharmacological approaches to treat neuropathic pain, such as intensive exercise, hydrotherapy, transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation, motor imagery programs (MIP), supportive psychotherapy, and cognitive behavior therapy. To perform these non-pharmacological therapies, a multidisciplinary team focused on individualizing pain management is needed.