Traitement pharmacologique des douleurs neuropathiques

Neuropathic pains are generally refractory to medical treatment. Although their pharmacolological treatment is still based on old drugs with often troublesome side effects, such as tricyclic antidepressants and carbamazepine, the introduction of newer and generally better tolerated drugs, such as the antiepileptics gabapentin and lamotrigine, topical local anaesthetics (for peripheral neuropathies) and tramadol, has enriched the arsenal of treatments against these pains. It is now also establisheed, that opioid drugs may be effective against neuropathic pains. However, approximately one third only of the patients achieve satisfactory relief with any of these treatments. Such therapeutic failures are related to the fact that the different neuropathic pain syndromes, although quite diverse, have generally been grouped together and treated in a uniform fashion. A more rational therapeutic approach, combined to the large number of drugs acting on new targets currently under development, should contribute to substantial progress in the therapeutic management of neuropathic pains.