Using stratified medicine to understand, diagnose, and treat neuropathic pain

Abstract

Neuropathic pain (NeuP) is defined as pain arising from a lesion or disease of the somatosensory nervous system. NeuP is common, affecting approximately 6-8% of the general population and currently treatment is inadequate due to both poor drug efficacy and tolerability. Many different types of injury can cause neuropathic pain including genetic (e.g. SCN9A gain of function variants), metabolic (e.g. diabetic polyneuropathy), infective (e.g. HIV associated neuropathy, hepatitis), traumatic and toxic (e.g. chemotherapy induced neuropathy) causes. Such injurious events can impact on anatomically distinct regions of the somatosensory nervous system ranging from the terminals of nociceptive afferents (in small fiber neuropathy) to the thalamus (in post-stroke pain). Classification of neuropathic pain using etiology and location remains an important aspect of routine clinical practice; however, pain medicine is coming to the realization that we need more precision in this classification. The hope is that improved classification will lead to better understanding of risk, prognosis and optimal treatment of NeuP