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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Neuropathic pain</title><author><name sortKey="Khan, Junad" sort="Khan, Junad" uniqKey="Khan J" first="Junad" last="Khan">Junad Khan</name><affiliation><nlm:aff id="aff1">Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, C 850, 07103, Newark, NJ, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27141158</idno><idno type="pmc">4837768</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837768</idno><idno type="RBID">PMC:4837768</idno><idno type="doi">10.4103/0972-4052.179317</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000558</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000558</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Neuropathic pain</title><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Indian Prosthodont Soc</journal-id><journal-id journal-id-type="iso-abbrev">J Indian Prosthodont Soc</journal-id><journal-id journal-id-type="publisher-id">JIPS</journal-id><journal-title-group><journal-title>The Journal of the Indian Prosthodontic Society</journal-title></journal-title-group><issn pub-type="ppub">0972-4052</issn><issn pub-type="epub">1998-4057</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27141158</article-id><article-id pub-id-type="pmc">4837768</article-id><article-id pub-id-type="publisher-id">JIPS-16-114</article-id><article-id pub-id-type="doi">10.4103/0972-4052.179317</article-id><article-categories><subj-group subj-group-type="heading"><subject>Guest Editorial</subject></subj-group></article-categories><title-group><article-title>Neuropathic pain</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Khan</surname><given-names>Junad</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib></contrib-group><aff id="aff1">Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, C 850, 07103, Newark, NJ, USA</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Junad Khan, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, C 850, 07103, Newark, NJ, USA. E-mail: <email xlink:href="khanju@sdm.rutgers.edu">khanju@sdm.rutgers.edu</email></corresp></author-notes><pub-date pub-type="ppub"><season>Apr-Jun</season><year>2016</year></pub-date><volume>16</volume><issue>2</issue><fpage>114</fpage><lpage>115</lpage><permissions><copyright-statement>Copyright: © The Journal of Indian Prosthodontic Society</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.</license-p></license></permissions></article-meta></front><body><p>Neuropathic pain (NP) is defined as “pain arising as a direct consequence of any lesion or disease affecting the somatosensory system.”[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref>] Although NP may be an idiopathic process reflecting abnormal sensory processing in the peripheral or central nervous system, it more often appears following physical insult or disease affecting the peripheral or central nervous system. It is likely that chronic peripheral neuropathy may lead to neuroplastic changes and affect the central nervous system. These functional and anatomical changes can exacerbate the overall experience of pain. As the changes become more chronic, co-morbid conditions such as sleep disorders, anxiety and depression can accompany the chronic pain, and further complicate treatment.</p><p>The prevalence of NP conditions is difficult to establish. There are many confounding factors that may lead to under-reporting of NP. In primary medical care settings, the prevalence has been reported to be between 2 and 11%.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>] Studies have focused on specific NP conditions, secondary to other pathological conditions. It has been shown that the about 26% of patients with type 2 diabetes can experience neuropathy. Cancer patients indicate a prevalence of 19–39. About 1% and 37% of chronic low back pain patients may have a neuropathic component related to it.[<xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref7" ref-type="bibr">7</xref>] Even with high prevalence in chronic conditions, the overall numbers of NP conditions tends to be small. One of the reasons is the lack of identification, diagnosis, and treatment. There is no standard approach between health care providers for NP. NP can be localized to the craniofacial region such as in trigeminal and glossopharyngeal neuralgia, painful traumatic trigeminal neuropathy (PTTN), burning mouth syndrome, or may affect other areas of the body such as in case of diabetic neuropathy. In the orofacial region, NP mainly affects the trigeminal nerve and can be referred to as Neuropathic Orofacial Pain (NOP).</p><p>Peripheral NP can be a result of nerve damage. Different types of nerve damage such as crush, transection, partial transection, and inflammatory insult can induce various clinical pain presentations and further complicate the process of diagnosis and management. In the orofacial region, development of pain following nerve damage (i.e., PTTN) is around 3–5%, which is low when compared to other parts of the body, where an incidence of painful traumatic neuropathy is 5–17%.[<xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref><xref rid="ref10" ref-type="bibr">10</xref><xref rid="ref11" ref-type="bibr">11</xref>] PTTN secondary to dental procedures can be a major complication. Third molar extractions have been reported to cause altered sensations in 0.3–1% of cases.[<xref rid="ref12" ref-type="bibr">12</xref><xref rid="ref13" ref-type="bibr">13</xref><xref rid="ref14" ref-type="bibr">14</xref>] Persistent pain after successful endodontics has been found to occur in 3–13% of the patients.[<xref rid="ref15" ref-type="bibr">15</xref><xref rid="ref16" ref-type="bibr">16</xref><xref rid="ref17" ref-type="bibr">17</xref>] The incidence of neurosensory disturbance post implant can range anywhere from 0.6 to 36%.[<xref rid="ref18" ref-type="bibr">18</xref><xref rid="ref19" ref-type="bibr">19</xref><xref rid="ref20" ref-type="bibr">20</xref><xref rid="ref21" ref-type="bibr">21</xref>]</p><p>Causes of central pain may include trauma, cerebrovascular injuries, tumors, multiple sclerosis, and Parkinson's disease. NP can also be classified based on frequency into continuous or episodic. Episodic neuropathies are usually characterized by short, sudden, sharp, or electrical like paroxysmal pain. The pain is usually severe and sporadic in nature. Continuous NP is usually characterized by continuous dull pain of mild to moderate intensity with occasional paroxysms of pain.</p><p>There is presently no definitive cure to this condition, and the available treatment requires long-term prescription medications with significant side effects. In some cases, surgical procedures and adjunctive therapy are also recommended. Evaluation of sensory alterations can be performed using quantitative sensory testing which is a noninvasive assessment of normal and abnormal responses of the nervous system to various stimuli. Mapping and sketches of the affected area can help treatment decisions and management. The medications used for NP can include antidepressants, anticonvulsants, antiarrhythmics, opioids and nonopioid analgesics, and topical medications.[<xref rid="ref22" ref-type="bibr">22</xref>] Adjunctive treatment can include but is not limited to a variety of options which include physical therapy, acupuncture, hypnosis, counseling, biofeedback, massage, relaxation, pressure, herbs, yoga, exercise, and electrotherapy. The prevailing “trial and error” approach to NP treatment includes a titration regimen of 3–8 weeks which is very often repeated several times before an effective medication for the individual patient is identified. As health care providers it is important to recognize NOP conditions to avoid unnecessary treatment and suffering.</p><sec disp-level="2" id="sec2-1"><title>Financial support and sponsorship</title><p>Nil.</p></sec><sec disp-level="2" id="sec2-2"><title>Conflicts of interest</title><p>There are no conflicts of interest.</p></sec></body><back><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Haanpää</surname><given-names>M</given-names></name><name><surname>Attal</surname><given-names>N</given-names></name><name><surname>Backonja</surname><given-names>M</given-names></name><name><surname>Baron</surname><given-names>R</given-names></name><name><surname>Bennett</surname><given-names>M</given-names></name><name><surname>Bouhassira</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>NeuPSIG guidelines on neuropathic pain 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