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Diagnosis, Mechanisms, and Treatment Recommendations

Robert H. Dworkin, PhD; Miroslav Backonja, MD; Michael C. Rowbotham, MD; Robert R. Allen, MD; Charles R. Argoff, MD; Gary J. Bennett, PhD; M. Catherine Bushnell, PhD; John T. Farrar, MD; Bradley S. Galer, MD; Jennifer A. Haythornthwaite, PhD; David J. Hewitt, MD; John D. Loeser, MD; Mitchell B. Max, MD; Mario Saltarelli, MD, PhD; Kenneth E. Schmader, MD; Christoph Stein, MD; David Thompson, PhD; Dennis C. Turk, PhD; Mark S. Wallace, MD; Linda R. Watkins, PhD; Sharon M. Weinstein, MD

Arch Neurol. 2003;60:1524-1534.

Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism–based approach.

From the Department of Anesthesiology, University of Rochester, Rochester, NY (Dr Dworkin); Department of Neurology, University of Wisconsin, Madison (Dr Backonja); Department of Neurology, University of California, San Francisco (Dr Rowbotham); AstraZeneca, Wilmington, Del (Dr Allen); Department of Neurology, North Shore University Hospital, Manhasset, NY (Dr Argoff); Department of Anesthesiology, McGill University, Montreal, Quebec (Drs Bennett and Bushnell); Department of Neurology, University of Pennsylvania, Philadelphia (Dr Farrar); Endo Pharmaceuticals, Chadds Ford, Pa (Dr Galer); Department of Psychiatry, Johns Hopkins University, Baltimore, Md (Dr Haythornthwaite); Ortho-McNeil Pharmaceutical, Raritan, NJ (Dr Hewitt); Departments of Neurosurgery (Dr Loeser) and Anesthesiology (Dr Turk), University of Washington, Seattle; Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, Department of Health and Human Services, Bethesda, Md (Dr Max); Pfizer, Groton, Conn (Dr Saltarelli); Department of Medicine and Geriatric Research, Education, and Clinical Center, Duke University and Durham VA Medical Centers, Durham, NC (Dr Schmader); Department of Anesthesiology, Freie Universität Berlin, Berlin, Germany (Dr Stein); Innovus Research Inc, Medford, Mass (Dr Thompson); Department of Anesthesiology, University of California, San Diego (Dr Wallace); Department of Psychology, University of Colorado, Boulder (Dr Watkins); and Department of Anesthesiology, University of Utah, Salt Lake City (Dr Weinstein).

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