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KMID : 0614520020120010046
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Journal of the Korean Pain Research Society
2002 Volume.12 No. 1 p.46 ~ p.61
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Nonpharmacologic Treatments for Neuropathic Pain
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Park Jung-Yul
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Abstract
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Refractoriness to the treatments for chronic neuropathic pain may be partly due to complex nature of pain, less effectiveness of conventional therapeutic measures, and associated psychosocial factors. Therefore, all currently available therapeutic modalities with multidisciplinary team approach are mandatory. Treatments other than pharmacologic therapy would include physiotherapy, biofeedback, relaxation training, psychologic counseling, and various surgical interventions (e.g., neuromodulative treatments in the form of chemical and electrical stimulation, and neurodestructive treatment). Here, author has intended to focus mainly on various types of surgical treatments for these chronically disabling patients with brief mention on other forms of conservative treatments other than pharmacologic thearpy. Although initial treatments for these patients are usually provided in conservative manner possible more aggressive beneficial therapeutic options should be acknowledged, considered and available, and not be considered as last resort, whenever appropriate. When surgery is considered, neuroaugmentative or neuromodulative procedures (e.g., peripheral and deep brain stimulation, chemical stimulation) are generally preferred as initial modalities. However, identification and management of sympathetically maintained pain, when suspected, should be carried out in early stage of treatment. With better understanding of pain mechanism and refined therapeutic modalities with advanced technical development it is becoming evident that there will be more to offer for these patients. However, only by careful selection of patient and of approach based upon diligent evaluation of individual cases can we hope to make future progress in these extraordinarily difficult pathologic conditions.
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KEYWORD
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Neuropathic pain, Neuromodulation
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