Pharmacological Treatment of

Neuropathic Pain

Joost Jongen

Brussels, June 13th, 2015

Introduction

• A diagnosis of neuropathic pain

• Pharmacological treatment of neuropathic

pain

• Neuropathic pain in cancer patients

A diagnosis of neuropathic pain-Hypothesis I

One should NOT treat neuropathic pain,

that is NOT neuropathic pain

A diagnosis of neuropathic pain

DRG

Motor

innervation

Sensory

innervation

A diagnosis of neuropathic pain

-Ataxia

-Loss of Touch

-Loss of Dexterity

Large

diamete

r

Small diameter

-Muscle Atrophy

-Loss of

Strength

Large

diameter

sensory nerve

fibers

-Autonomic dysfunction

-Loss of thermo-perception

-Neuropathic Pain

Motor nerve

fibers

Small diameter

sensory nerve

fibers

A diagnosis of neuropathic pain

Manuscript in preparation

A diagnosis of neuropathic pain

Manuscript in preparation

A diagnosis of neuropathic pain

Treede et al. Neurology 2008; 70: 1630-1635

Pharmacological treatment of neuropathic pain-Hypothesis II

One should NOT treat mild neuropathic

pain

Pharmacological treatment of neuropathic pain

Lancet Neurol. 2015; 14: 162-173

Pain Practice 2014; 14(3): 183-295

Pharmacological treatment of neuropathic pain

Pain Practice 2014; 14(3): 183-

295

Pain 2014; 155: 2263-

2273

Pharmacological treatment of neuropathic pain-Hypothesis III

Pharmacological treatment of

neuropathic pain should be based on

clinical evidence and rational

pharmacotherapy

Pharmacological treatment of neuropathic pain

Groeneveld & Jongen. Tijdschr. Neurol. Neurochir. 2013; 114:

119-129

Pharmacological treatment of neuropathic pain

Groeneveld & Jongen. Tijdschr. Neurol. Neurochir. 2013; 114:

119-129

Pharmacological treatment of neuropathic pain

Pain Practice 2014; 14(3): 183-295

Neuropathic pain in cancer patients-Hypothesis IV

Neuropathic pain in cancer patients is a

special entity, that encompasses both

mixed and purely neuropathic pain

Neuropathic pain in cancer patients

• Nociceptive pain (due to cancer)

• Mixed nociceptive-neuropathic pain (due to

cancer)

• Purely neuropathic cancer pain (due to

cancer treatment)

Neuropathic pain in cancer patients-Nociceptive pain (?)

Soc. Neurosci. Abstr. 2002

Neuropathic pain in cancer patients-Mixed pain

Neuropathic pain in cancer patients-Purely neuropathic pain

J. Neurooncol. 2015; 121: 229-237

Pharmacological treatment of neuropathic pain in cancer patients

J Pain Symptom Manage. 2013; 46: 581-590

Conclusions

• One should not treat neuropathic pain, that is

not neuropathic pain

• One should not treat mild neuropathic pain

• Pharmacological treatment of neuropathic

pain should be based on clinical evidence

and rational pharmacotherapy

• Neuropathic pain in cancer patients is a

special entity, that encompasses both mixed

and purely neuropathic pain