RESUMO
BACKGROUND: Neuropathic pain is described as burning, painful, cold or electric shocks and may be associated with tingling, pins and needles, numbness or itching. OBJECTIVE: This article summaries the diagnosis and management of four common neuropathic pain presentations. DISCUSSION: A validated diagnostic screening tool can help identify patients with neuropathic pain. A systematic approach to clinical assessment and investigation will clarify the diagnosis. Good glycaemic control is important in the prevention and management of diabetic polyneuropathy; management options include antidepressants, gabapentinoids and controlled release opioids. Pain that lasts for more than 3 months after the onset of a herpes zoster infection is called 'postherpetic neuralgia'; management options include prevention with vaccination, early antiviral treatment and gabapentinoids, tricyclic antidepressants, controlled release opioids, capsaicin cream and lignocaine patches. In trigeminal neuralgia, patients complain of severe brief episodes of pain in the distribution of one or more branches of the fifth cranial nerve; first line management is with carbamazepine. Complex regional pain syndrome is diagnosed using the Budapest Diagnostic Criteria. Few clinical trials are available to guide the treatment of complex regional pain syndrome, which includes pharmacological and surgical options.
