Neuropathic pain is defined as pain caused by lesions or diseases of the somatosensory system. Management of neuropathic pain is difficult owing to the heterogeneity of underlying causes and absence of objective standards for diagnosis and assessment of neuropathic pain. In this review, we reviewed the recently published guidelines regarding the pharmacological management of neuropathic pain including the French recommendations and the German Neurological Association guidelines, and the American Neurological Association's guidelines for the management of diabetic polyneuropathy. In general, drugs recommended as the first-line treatment for neuropathic pain include gabapentinoid, serotonin–norepinephrine reuptake inhibitor (SNRI), and tricyclic antidepressants. As the second-line treatment, combination of SNRI or tricyclic antidepressant with gabapentinoid could be recommended. Although tramadol and tapentadol are recommended as the second- or third-line treatment, caution is required in long-term use of these medications due to the side effects including dependence and abuse. Besides efficacy, it is necessary to consider the side effects of the medication and underlying disease of the patient in selecting pharmacological treatment.
Noninvasive stimulation of the nervous system for treating chronic neuropathic pain has received attention because of its tolerability and relative efficacy. Repetitive transcranial magnetic stimulation (rTMS) is a representative method of noninvasive brain stimulation. Evidence-based guidelines on therapeutic use of rTMS have been proposed recently for several neurological diseases. These guidelines recommend treating neuropathic pain by applying high-frequency (≥ 5 Hz) rTMS to the primary motor cortex contralateral to the painful side. This review summarizes the mechanisms and guidelines of rTMS for treating neuropathic pain, and proposes directions for future research.
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Korean Society of Intraoperative Neurophysiological Monitoring , Korean Neurological Association , Korean Academy of Rehabilitation Medicine , Korean Society of Clinical Neurophysiology , Korean Association of EMG Electrodiagnostic Medicine
Ann Clin Neurophysiol 2021;23(1):35-45. Published online April 29, 2021
The utility and accuracy of intraoperative neurophysiological monitoring (IONM) has evolved greatly following the recent development of new devices for neurophysiological testing and advances in anesthesiology. Until recently, the need for IONM services has been limited to large academic hospitals, but the demand for neurophysiologists with expertise in IONM has grown rapidly across diverse types of hospital. The primary goal of the Korean Society of Intraoperative Neurophysiological Monitoring (KSION) is to promote the development of IONM research groups and to contribute to the improvement of fellowship among members and human health through academic projects. These guidelines are based on extensive literature reviews, recruitment of expert opinions, and consensus among KSION board members. This version of the guidelines was fully approved by the KSION, Korean Association of EMG Electrodiagnostic Medicine, the Korean Society of Clinical Neurophysiology, the Korean Academy of Rehabilitation Medicine, and the Korean Neurological Association.
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Chronic non-specific low back pain (CLBP) is one of the major health problems casting substantial amount of economicexpenses and negative impact on quality of life onto an individual as well as society. On contrary to public familiarity, theways of management of CLBP are diverse and there is yet no general consensus about which approach is better than othersor to whom the specific management should be applied. Some hold the negative point of view on the efficacy of the invasivemaneuver such as epidural injection because there is no controlled clinical trial (RCT) yielding better long term outcomeof those invasive managements over conservative ones. But the experts of interventional or surgical treatment stress the methodologicaldifficulty in performing RCT and assert that those invasive treatments can bring the prompt and complete resolutionof low back pain and restoration of function in appropriately selected cases. These seemingly opposite views on theinvasive management on CLBP are rather complimentary each other than to be contradictory.
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