[Neuropathic pain: Pharmacotherapy]

Neuropathic pain: Pharmacotherapy Abstract. The identification and treatment of neuropathic pain (NP) still represents a major challenge to an interdisciplinary team. Specific pharmacotherapy is an important pillar of a multimodal therapy strategy that should finally follow a biopsychosocial approach. Unfortunately, classic WHO-Step-I analgesics fail to treat NP. According to current evidence, a permanent therapy with opioids (WHO-Step-II and -III) exposes patients to long-term risks that can hardly justify the midterm success of these substances. Therefore, knowledge of the dosage, use and side effects of the first-line drugs such as tricyclic antidepressants (TCA), serotonin-norepinephrine reuptake inhibitors (SNRI) and gabapentinoids is essential. Treatment should follow the "start low, go slow" concept, while a good patient education is crucial. Topical therapy with Lidocaine and Ambroxol actively includes the patient in the therapy regimen. High-dose therapy with capsaicin patches (8 %) remains in the hands of pain specialists. Perioperative prevention of neuropathic pain with systemic medication failed to prove efficacy by now. However, the perineural application of local anaesthetics using nerve blocks in thoracic and breast surgery as well as in caesarean section showed potential to prevent chronic, postoperative pain (CPOP). In the case of systemic diseases causing neuropathies, such as diabetes mellitus, active herpes zoster, multiple sclerosis, malnutrition, the optimization of a causal drug therapy stays eminently important.