Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that persists for more than three months after the resolution of herpes zoster rash. This condition affects approximately 30% of the population, primarily the elderly and immunocompromised individuals. PHN can be severely debilitating and often proves challenging to treat effectively. Recent advances in prevention and treatment have improved the management of PHN. The introduction of herpes zoster vaccines has shown promise in reducing the incidence of both herpes zoster and PHN. Current treatment guidelines recommend a multimodal approach, with effective therapies including tricyclic antidepressants, topical lidocaine, gabapentin, pregabalin, opioids, and topical capsaicin. This review focuses on optimizing treatment strategies and developing novel therapies to further enhance PHN management.

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.

Nociplastic pain refers to pain arising from altered nociception without evidence of tissue or somatosensory damage. It encompasses various clinical conditions with shared neurophysiological mechanisms involving different organ systems. Nociplastic pain can occur independently or alongside chronic pain conditions with a nociceptive or neuropathic origin. This review introduces the concept of nociplastic pain, its clinical manifestations and the underlying pathophysiology. Taking a biopsychosocial approach can lead to a better understanding of nociplastic pain and improved treatment outcomes for affected individuals.

Citations

• Aktualisierung der DEGAM-S1-Handlungsempfehlung zum chronischen, nichttumorbedingten Schmerz
  Cornelia Straßner, Annette Becker
  Zeitschrift für Allgemeinmedizin.2024; 100(6): 307.     CrossRef

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.

Citations

• Efficacy of repetitive transcranial magnetic stimulation for phantom limb pain- a meta analysis of randomized controlled trials
  FNU Chandni, FNU Savanti, Rohit Kumar, Murk Raj, Aakash Kumar, Aashish Kumar, Sejal Kinger, Sahil Kumar, Himat Rai, Afsana Ansari Shaik, Muhammad Sohaib Asghar
  Neurological Sciences.2025; 46(5): 2019.     CrossRef
• Impact of Titanium Skull Plate on Transcranial Magnetic Stimulation: Analysis of Induced Electric Fields
  Mai Lu, Shoogo Ueno
  Life.2024; 14(5): 642.     CrossRef
• Synaptic sensitization in the anterior cingulate cortex sustains the consciousness of pain via synchronized oscillating electromagnetic waves
  Richard Ambron
  Frontiers in Human Neuroscience.2024;[Epub]     CrossRef
• Dualism, Materialism, and the relationship between the brain and the mind in experiencing pain
  Richard Ambron
  Neuroscience.2024; 561: 139.     CrossRef

Neuropathic pains refer to a heterogenous group of pain condition characterized by lesion or dysfunction of the normal sensory pathways. Clinical characteristics include: delayed onset of pain after nervous system lesion, pain in are of sensory loss, spontaneous and different evoked types of pain. It is very important to diagnose neuropathic pain accurately and to manage effectively. It is evitable to get good information from persons in neuropathic pain through good rapport between doctors and patients during history taking. We should do detailed history taking and physical examination that is essential to approach our goal. Simple guideline should be developed for physical examination and laboratory test.

Patient with neuropathic pain comprises up to 1% of population. As the underlying mechanism of neuropathic pain(NeP) is not fully understood, definition of NeP is not clearly established as well. Patients frequently complain their pain by diverse terms. Also, same symptom has different underlying mechanisms and same disease causes variable types of neuropathic pains. In this sense, traditional treatment of neuropathic pain targeted specific syndromes are not reasonable. Clinicians should know the specific treatment according to the mechanisms causing neuropathic pain. Treatment should be fit to their symptoms and signs representing mechanism.