Management is more than pills

doi:10.1136/bmj.b3502

Published 1 September 2009, doi:10.1136/bmj.b3502
Cite this as: BMJ 2009;339:b3502

Letters

Neuropathic pain

Management is more than pills

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

We have one important caveat in relation to Freynhagen and Bennett’sreview—that evidence based non-pharmacological treatmentfor neuropathic pain was absent.¹

Several randomised controlled trials show that graded motorimagery reduces pain and disability in chronic complex regionalpain syndrome 1 (CRPS1) and phantom limb pain after amputationor brachial plexus avulsion injury.² The number needed to treatfor a 50% decrease in pain and a four point drop on a 10 pointscale of disability is around 4,³ which compares favourablywith any other treatment for chronic CRPS1, including spinalcord stimulation.¹ Cognitive behavioural programmes reduce disabilityand pain in a range of neuropathic pain states,⁴ and sensorydiscrimination training reduces pain in chronic phantom limbpain and possibly chronic CRPS1.⁵

These treatments were devised, and continue to be refined forpeople with chronic neuropathic pain, since the discovery ofrobust and profound changes within the central nervous system,. . . [Full text of this article]

Michael Thacker, senior lecturer¹, G Lorimer Moseley, NHMRC senior research fellow², Herta Flor, professor³

¹ Academic Department of Physiotherapy and Wolfson Centre for Age Related Diseases, King’s College London, London, ² Prince of Wales Medical Research Institute and Faculty of Medicine, University of New South Wales, Sydney, Australia, ³ Department of Clinical and Cognitive Neuroscience, University of Heidelburg, Heidelburg, Germany

michael.thacker@kcl.ac.uk