Neuropathic pain in soft tissue complaints

Many soft tissue complaints are associated with the development of neuropathic pain. This pain is produced by pathophysiological processes that are different to the processes involved in the generation of the inflammatory or nociceptive pain more commonly encountered in soft tissue disorders. One of the consequences of this is that neuropathic pain can often be less responsive to standard analgesic therapies. The use of alternative analgesic strategies may be necessary if we are to treat neuropathic pain successfully.

This chapter aims to outline some of the clinical features associated with neuropathic pain, the aetiological factors leading to its development and the evidence base (or lack) behind current treatment strategies. It will try to provide a rational approach to the management of neuropathic pain in patients with soft tissue disorders, particularly focusing on pharmacological management.

Neuropathic pain is the focus of much current research activity, particularly pharmacological research, and this chapter will attempt to identify gaps in our clinical knowledge and highlight opportunities for further research.

Key words: neuropathic pain, neuralgia, intractable pain, chronic pain, myalgia, soft tissue disorders, fibromyalgia, CRPS, complex regional pain syndrome, analgesics, antidepressants, anticonvulsants, opioid analgesics, muscle relaxants, NMDA antagonists, cannabinoids, capsaicin, local anaesthetics, pain management