Guidelines for the treatment of neuropathic pain in South Africa
Neuropathic pain is defined as pain that originates due to a lesion, dysfunction or disease, e.g. diabetes, HIV infection, herpes zoster, chemotherapy or surgery, and which affects the peripheral or central nervous system. This results in abnormal neural function, often presenting in an individual as sensory pain-related symptoms which are either positive, i.e. hyperaesthesia or hyperalgesia; or negative, i.e. hypoaesthesia or anaesthesia. The quality of life of patients with neuropathic pain is often compromised as many have difficulty sleeping, lack energy, and experience drowsiness and altered concentration, and this can potentially progress to a stage in which the patient is physically and psychologically distressed. In 2012, an expert panel proposed clinical guidelines for the treatment of neuropathic pain in the South African context. These guidelines shifted from traditional pain management, primarily comprised of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, to alternative therapeutic agents including pregabalin, gabapentin, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors (SNRIs) and opioids. Recent studies have suggested that melatonin, a neurohormone responsible for regulating the circadian rhythm, may be a potential therapeutic agent for symptoms associated with neuropathic pain. The guidelines reviewed in this article offer healthcare providers with a concise stepwise approach with which to diagnose and treat neuropathic pain.