Neuropathic pain: From actual pharmacological treatments to new therapeutic horizons

Pharmacol Ther. 2023 Nov:251:108546. doi: 10.1016/j.pharmthera.2023.108546. Epub 2023 Oct 11.

Abstract

Neuropathic pain, caused by a lesion or disease affecting the somatosensory system, affects between 3 and 17% of the general population. The treatment of neuropathic pain is challenging due to its heterogeneous etiologies, lack of objective diagnostic tools and resistance to classical analgesic drugs. First-line treatments recommended by the Special Interest Group on Neuropathic Pain (NeuPSIG) and European Federation of Neurological Societies (EFNS) include gabapentinoids, tricyclic antidepressants (TCAs) and selective serotonin noradrenaline reuptake inhibitors (SNRIs). Nevertheless these treatments have modest efficacy or dose limiting side effects. There is therefore a growing number of preclinical and clinical studies aim at developing new treatment strategies to treat neuropathic pain with better efficacy, selectivity, and less side effects. In this review, after a brief description of the mechanisms of action, efficacy, and limitations of current therapeutic drugs, we reviewed new preclinical and clinical targets currently under investigation, as well as promising non-pharmacological alternatives and their potential co-use with pharmacological treatments.

Keywords: Anticonvulsants; Antidepressants; Clinical trials; Neuropathic pain; Neurostimulation; New therapeutics; Pharmacological drugs; Treatment.

Publication types

  • Review

MeSH terms

  • Analgesics / adverse effects
  • Antidepressive Agents* / pharmacology
  • Humans
  • Neuralgia* / drug therapy
  • Norepinephrine
  • Selective Serotonin Reuptake Inhibitors

Substances

  • Antidepressive Agents
  • Analgesics
  • Selective Serotonin Reuptake Inhibitors
  • Norepinephrine