Pharmacotherapy and Medical Management for Neuroma and Neuropathic Pain

The pharmacologic management of neuroma and neuropathic pain has a long history with suboptimal results in many cases. Effective treatment remains challenging due to the diverse pain etiologies and mechanisms at play. These include structural and functional changes that occur peripherally within neuromas, as well as alterations that occur centrally within the brain and spinal cord. While surgical management is beginning to show promise, pharmacological management remains indispensable. Although different medications may alleviate specific subtypes of neuropathic pain, no single medication has demonstrated consistent and superior efficacy. A multimodal approach with a combination of different classes of medications is likely to be optimal, with the goal to minimize opioid use and to capitalize on synergistic effects of nonopioid medications. Finally, there are experimental agents (e.g., 4-AP and EPO) demonstrating promise in management of these difficult clinical situations.