Vol 13, No 3 (2019)
Review paper
Published online: 2019-09-13
Neuropathic pain: new mechanisms of action of old drugs
Palliat Med Pract 2019;13(3):123-128.
Abstract
Approximately 7–10% of the general population and 30% of cancer patients suffer from neuropathic
pain, which is induced by the damage or disease of the neurologic structures. Sometimes neuropathic
pain is caused by the pressure on a nerve but more often pain is due to the sensitization of the centers in
the spinal cord and brain. Some structures become so sensitive to the peripheral pain impulses that they
become totally independent of them. Recently neuropathic pain is seen as an activation process of the
innate immunologic system. In this area the Toll-like receptors seems to play an important role and many
drugs are able to inhibit their activation. Treatment of neuropathic pain depends on the possibility of nerve
decompression. However, in many cases, the sensitization is the target for treatment. For this purpose,
most useful are gabapentinoids that inhibit influx of calcium across the membrane. Antidepressants (SNRI)
such as duloxetine and venlafaxine are also useful as well as tricyclic antidepressants, although the latter
are characterized by significant adverse effects. In some types of neuropathic pain 8% capsaicin, as well as
5% lidocaine plasters or different opioids, are successfully used although there is still a lack of sufficient,
good quality controlled clinical trials. The description of the role of Toll-like receptors in the pathophysiology
of neuropathic pain is a breakthrough in thinking and hope for the future to elaborate new, more
effective treatment methods.
Palliat Med Pract 2019; 13, 3: 123–128
Keywords: neuropathic painsensitization of the central nervous systemtricyclic antidepressantsgabapentinpregabalinopioids
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