Published 12 August 2009, doi:10.1136/bmj.b3002
Cite this as: BMJ 2009;339:b3002

Clinical Review

Diagnosis and management of neuropathic pain

R Freynhagen, associate professor1, M I Bennett, professor2

1 Department of Anaesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Krankenhaus Tutzing, 82327 Tutzing, Germany, 2 International Observatory on End of Life Care, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT

Correspondence to: R Freynhagen r.freynhagen@krankenhaus-tutzing.de

The first 150 words of the full text of this article appear below.


Neuropathic pain commonly presents in primary care and is often unrecognised
Diagnosis is based on characteristic symptoms, altered sensation, and a clinical history that matches a neuroanatomical or dermatomal pattern
Less than half of patients achieve significant benefit with any single drug
Management includes making pain tolerable and maintaining emotional and physical functioning
Non-pharmacological approaches can be effective, but referral for specialist help is indicated if pain persists or remains uncontrolled


Neuropathic pain arises from damage, or pathological change, in the peripheral or central nervous system. It is usually a chronic condition that can be difficult to treat because standard treatment with conventional analgesics does not typically provide effective relief of pain. Patients with neuropathic pain commonly present to primary care professionals, but making a diagnosis may be difficult. Neuropathic pain is usually associated with substantially greater impairment of quality of life compared with other types of chronic pain, and . . . [Full text of this article]

Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine)
{alpha}2-{delta} anticonvulsants (gabapentin and pregabalin)
Serotonin and norepinephrine reuptake inhibitors (duloxetine, venlafaxine)
Topical 5% lidocaine patch

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This article has been cited by other articles:

  • Thacker, M., Moseley, G L., Flor, H. (2009). Management is more than pills. BMJ 339: b3502-b3502 [Full text]  

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