Pharmacotherapy of neuropathic pain

Neuropathic pain is a significant problem due to significant incidence and difficulties in effective treatment. Neuropathic pain component is frequent among cancer patients due to co-existence of nervous system changes in patients with bone pain and common use of neurotoxic methods of cancer treatment: radiotherapy, chemotherapy and molecular therapies. The diagnosis of neuropathic pain can be established by means of detailed history taking, clinical symptoms and physical examination, imagine investigations, quantitative sensory testing and validated questionnaires. The treatment of neuropathic pain in cancer patients is based mainly on pharmacotherapy with opioids recommended as first-line agents for the treatment. Among patients with non-malignant pain adjuvant analgesics, especially antidepressants and anticonvulsants are first-line drugs. In localized neuropathic popain local anesthetics and drugs acting on vanillin receptors play a significant role. In this patient group there is a limited role of opioids which form a second or a third line of treatment when other drugs are ineffective. A limited role is attributed to other drugs such as corticosteroids, NMDA receptor antagonists and botulinum toxin. In some patients interventional techniques play a significant role and in cancer patients oncology treatment (local — mainly radiotherapy and systemic — mainly chemotherapy, hormone manipulation and molecular therapies) should be carefully considered. Therapy of neuropathic pain should be an important element of a wider holistic plan of the treatment, which takes into account a meticulous assessment of pain and other symptoms, evaluation of patients and caregivers needs with the aim of a complex therapeutic approach as an effective treatment of symptoms, psychosocial and spiritual support, which significantly improve the quality of life of both patients and caregivers