Neuropathic pain: Incorporating new consensus guidelines into the reality of clinical practice

The recently developed consensus guidelines on the treatment of neuropathic pain reflects our ability to use evidence-based medicine for rational pharmacotherapy in a group of disorders that is often difficult to treat. Neuropathic pain arises from abnormalities in various points in the nervous system and impacts the emotional and psychological status of the affected individual. Because no 2 persons have identical nervous systems, neuropathic pain is a unique disease state for each individual. These guidelines provide a framework, based on published efficacy and safety studies, to provide the healthcare provider with a choice of first-line therapies for neuropathic pain patients. However, as with many areas of medicine, successful outcomes are achieved when both the art and science of medicine are applied. In treating neuropathic pain, the medical "art" may be found in the clinical experience of pain specialists, but may not appear in the published literature. This article is a summary of presentations and discussions by a panel of pain specialists from pain medicine, neurology, anesthesiology, psychiatry, pharmacy, primary care, and nursing. Collectively, the panel members offer their insights into application of these guidelines in real-world clinical experience. The goal is to provide the nonspecialist healthcare team the information and the confidence to treat neuropathic pain with a rational treatment approach and to provide a comprehensive treatment plan aimed at improving clinical outcomes.