Therapeutic advances in pharmaceutical treatment of neuropathic pain

Neuropathic pain is difficult to treat. Recommended first-line treatments include tricyclic antidepressants and alpha2delta agonists pregabalin and gabapentin for multiple neuropathic conditions, the antidepressants duloxetine and venlafaxine in diabetic painful neuropathies and lidocaine patches for postherapetic neuralgia. Therapeutic prospects include focal therapy with sustained analgesic efficacy (capsaicin patches, botulinum toxin), treatments acting on new targets (i.e., cytokine inhibitors, metabotropic glutamate inhibitors, TRPV1 antagonists). The methodology of clinical trials also tends to take better into account the symptomatic profiles of patients, which should contribute to better prediction or responders to treatment.