Presse Med
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Nondrug treatments of neuropathic pain should always begin at the same time as pharmacologic treatment. There are three types of nondrug treatment for neuropathic pain: physical, surgical, and "psychocorporal" and psychotherapeutic treatment. Transcutaneous electrical nerve stimulation (TENS) is a simple physical treatment that strengthens local inhibitory controls and is indicated in focal neuropathic pain when upstream stimulation is possible for a superficial sensitive nerve trunk. ⋯ Functional surgery is implanted electric stimulation--either spinal or central (encephalic)--of structures that exert inhibitory control on the pain pathways. Spinal stimulation is performed at the level of the posterior spinal cord and is indicated essentially in segmental mononeuropathies refractory to drug treatment. Central stimulation is performed at the motor cortex and is indicated for refractory central pain. "Psychocorporal" techniques (relaxation, sophrology, hypnosis) are useful to reduce anxiety and neurovegetative hypertonicity, both factors that aggravate neuropathic pain.
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Neuropathic pain remains difficult to treat. Treatments with established efficacy in several neuropathic conditions include tricyclic antidepressants, gabapentin, pregabalin and strong opioids. Duloxetine and venlafaxine, both antidepressants, and tramadol, an opioid agonist, are also known to be effective in painful polyneuropathies, while lidocaine patches produce analgesic effects, mainly in postherpetic neuralgia. Studies show that pregabalin, gabapentin and duloxetine have positive effects that improve quality of life, and anxiety, depressive, and sleep disorders.
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Decisions about treatment prescriptions depend on many factors. For example, the choice of once-daily or multiple administration of an analgesic, an aspect that is not determined by guidelines, depends essentially on medical practice habits, patient preferences, or both. We analyzed this treatment decision for acute back pain in a case-control study. ⋯ The choice of type of analgesic treatment for acute back pain depends not only on clinical condition (pain and disability), but also on clinical history, the future as envisioned by the physician and the patient's desires. Action to improve treatment choices must integrate these factors, especially as part of an overall education in therapeutics.