Pharmacological treatment of neuropathic low backpain

Thordarson, Hrafn
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The topic of my thesis is a discussion of neuropathic elements in low back pain, a very common condition, and the pharmacological treatment modalities in LBP both with and without neuropathy. Up to 84% of the population will present with low back pain at some point in their life and neuropathic components are associated with worse outcomes. Treatment of neuropathic pain with available drugs has been and continues to be a difficult subject were most patients do not experience full pain relief. Treatment options for LBP are varied, the nociceptive pain element of LBP can often be controlled with NSAIDs and a multidisciplinary approach to pain management, including group CBT, physiotherapy and good patient education and these should generally be considered the first-line treatment for LBP. Some novel approaches to the neuropathic element of LBP are promising, including tapentadol, capsaicin patches, and antidepressants, like TCAs and SNRIs. Some drugs effective in other neuropathic pain syndromes, like the anticonvulsants gabapentin and pregabalin have shown limited efficacy in neuropathic LBP even though they’re still commonly cited as first line therapies. Even so, our measure of successful treatment in CLBP typically only signifies a reduction in everyday pain levels of over 30%.
Back Pain, Low Back Pain, Neuropathy, Pharmacology, Treatment, Radiculopathy