Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence

Peripheral neuropathic pain is the term used to describe situations where nerve roots or peripheral nerve trunks have been injured by mechanical and/or chemical stimuli that exceeded the physical capabilities of the nervous system. Clinical manifestations of peripheral neuropathic pain are often discussed in terms of positive and negative symptoms. Positive symptoms reflect an abnormal level of excitability in the nervous system and include pain, paresthesia, dysesthesia, and spasm. Negative symptoms indicate reduced impulse conduction in the neural tissues and include hypoesthesia or anesthesia and weakness. It is proposed that conservative management incorporating neurodynamic and neurobiology education, nonneural tissue interventions, and neurodynamic mobilization techniques can be effective in addressing musculoskeletal presentations of peripheral neuropathic pain. While a small amount of clinical evidence lends some support to this proposal, much more clinical research is necessary to identify those patients with peripheral neuropathic pain that will respond most favorably to neurodynamic mobilization techniques and clarify specific treatment parameters that will be most effective. Regardless of the results of this future research, conservative care will always need to be based on sound clinical reasoning so that interventions can be individualized to address the nuances of each patient's presentation of peripheral neuropathic pain.