Neuropathic low back pain in clinical practice
1Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
European Journal of Pain (London, England)
|March 4, 2016
Summary
Neuropathic mechanisms are often under-recognized in chronic low back pain (LBP). New treatments like tapentadol and topical agents show promise for managing this challenging pain component.
Area of Science:
- Pain Medicine
- Neurology
- Pharmacology
Background:
- Low back pain (LBP) is a prevalent chronic pain condition.
- Neuropathic mechanisms in LBP are frequently under-recognized and undertreated.
- Current treatments for LBP often fail to address the neuropathic component effectively.
Purpose of the Study:
- To review the literature on neuropathic mechanisms in chronic LBP.
- To discuss the implications for clinical management, focusing on pharmacological treatments.
- To identify effective treatment options for the neuropathic component of LBP.
Main Methods:
- Conducted literature searches in PubMed, key pain congresses, and ProQuest Dialog.
- Assessed all titles for relevant published evidence on neuropathic back pain and its management.
- Focused on identifying studies related to pharmacological interventions.
Main Results:
- Chronic LBP involves both nociceptive and neuropathic pain.
- Many LBP patients are refractory to existing treatments, with limited efficacy and adverse effects from oral pharmacotherapies.
- Tapentadol, capsaicin 8% patch, and lidocaine 5% medicated plaster show potential for treating the neuropathic component of LBP.
Conclusions:
- Chronic LBP frequently includes an under-recognized neuropathic component requiring better diagnosis and treatment.
- Improved understanding of neuropathic LBP can lead to mechanism-based therapies.
- Tapentadol and topical analgesics represent potential effective options for specific patient groups with neuropathic LBP.
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
646
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
646
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
1.9K
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
1.9K