Neuropathic pain : the clinical syndrome revisited.
|2001, N° 1 (Vol. 101/1)|
|Neuropathic pains associated with an injury of the
peripheral or central nervous system are among the
most difficult to treat. One of the reasons for the therapeutic
difficulties in these patients is that the pharmacological
treatments are used in a uniform fashion whatever
the clinical picture, while these syndromes are in
fact highly heterogenous. The patients can express various
combinations of painful symptoms spontaneous
(continuous and/or paroxysmal) and evoked (allodynia
and/or hyperalgesia). Recent pharmacological studies
have shown that current treatments of these pains do not
induce global and uniform analgesic effects but rather
act preferentially or selectively on some of their components.
Such data emphasize the necessity of a thorough
evaluation of patients presenting with neuropathic
pains, notably by using quantitative sensory testing.
Following recent advances in the understanding of the
pathophysiological mechanisms underlying these pain-ful
syndromes, through experimental studies in animals,
a "mechanism-based" classification and treatment of
neuropathic pains can be envisaged. The main goal for
clinicians is to propose new methods and strategies for
identifying pathophysiological mechanisms in patients
in order to validate such an approach in the clinical context.|
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