Neuropathic Pain (NP) is a common and frequently occurring disease in clinical practice, which seriously affects the quality of life of patients. However, the treatment of NP has always been a clinical challenge. In order to standardize the diagnosis and treatment of NP and improve treatment effectiveness, the Pain Disease Branch of the Chinese Elderly Health Association organized experts to develop the "Chinese Neuropathic Pain Diagnosis and Treatment Guidelines (2024 Edition)". This article will interpret the guidelines to help everyone better understand the key points of diagnosis and treatment for NP.
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NP refers to pain caused or resulting from primary damage or dysfunction of the nervous system. It can be central or peripheral, caused by a variety of diseases, such as herpes zoster, diabetes, trauma, etc.
NP can be divided into two categories: central NP and peripheral NP. Central NP is often caused by diseases such as stroke, spinal cord injury, and multiple sclerosis; Peripheral NP is mostly caused by trauma, infection, diabetes and other factors.
The clinical manifestations of NP are diverse, including spontaneous pain, hyperalgesia, and allodynia. The nature of pain can be electric shock like, needle like, burning like, etc., and is often accompanied by emotional and sleep disorders.
The diagnosis of NP is mainly based on medical history, physical examination, neuroelectrophysiological examination, imaging examination, etc. The diagnostic criteria for NP recommended by the International Association of Pain Societies (IASP) in 2008 include pain located within a clear neuroanatomical range, medical history indicating nerve damage or disease, and auxiliary examination confirming nerve damage or disease.
The treatment of NP should follow the principles of "moving the gateway forward, early intervention, prevention of sensitization, and prevention and treatment of chronic pain". The treatment methods include drug therapy, physical therapy, minimally invasive intervention therapy, surgical treatment, etc., and individualized treatment plans need to be selected.
Anticonvulsant drugs, such as gabapentin and pregabalin, relieve pain by regulating neurotransmitter balance.
Antidepressants, such as amitriptyline and duloxetine, not only have antidepressant effects but can also alleviate NP.
When first-line drug treatment is ineffective, opioid drugs can be considered as second-line treatment. However, attention should be paid to the addictive nature and side effects of opioid drugs.
Physical therapy includes methods such as electrical stimulation, cold and hot compress, massage, etc., which can help improve blood circulation, reduce muscle tension, and promote nerve function recovery.
Minimally invasive intervention therapy includes techniques such as nerve block, pulsed radiofrequency, and nerve destruction, which have the advantages of minimal trauma and fast recovery. Suitable for NP patients with poor drug treatment efficacy.
For some NP patients, such as those with trigeminal neuralgia, surgical treatment such as microvascular decompression may be considered.
NP patients often have psychological problems such as anxiety and depression, and psychological therapies such as cognitive-behavioral therapy can help alleviate their psychological stress and pain. At the same time, patients should also strengthen self-management, maintain good living habits and mentality.
The Chinese Guidelines for the Diagnosis and Treatment of Neuropathic Pain (2024 Edition) provide important references for the standardized diagnosis and treatment of NP. By following the treatment principles and recommended plans in the guidelines, we can better manage NP patients and improve their quality of life. I hope the interpretation of this article can help everyone better understand and apply this guide.
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