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Treatment of neuropathic pain: historical aspects.

Since the earliest descriptions of pain related to injury of the nervous system, it has been recognized that the characteristics of this type of pain differ markedly from those of pain due to nonneural tissue damage. Later, as new analgesics were developed, it became clear that neurogenic pain was very often refractory to these drugs. This brief article considers some historical aspects of the development of treatments for neuropathic pain. All pain clinicians would accept that the current armamentarium of therapies for neuropathic pain is limited, a fact that reflects our poor understanding of the pathophysiology of neuropathic pain and inability to target treatments specifically and selectively. Closely related to this is the continuing debate over exactly what we mean when we use the term neuropathic pain.

Fothergill is credited with the earliest description of trigeminal neuralgia, though he did not use the term neuralgia, which came into use some years later [1–3]. There followed descriptions of pain arising as a result of both central and peripheral nervous system damage. Important landmark descriptions of central nervous system pathology causing pain included those of vascular lesions [4,5]. Dejerine and Roussy described the thalamic syndrome in 1906 [6] and, in a masterpiece of clinicopathologic correlation, Head and Holmes [7] detailed the sensory consequences (including pain) of cerebral lesions at different sites. Holmes later recognized that similar pain could be caused by spinal cord lesions [8]. Behan [9] coined the term “central pain” (CP), and Riddoch [10] provided a definition of CP that has stood the test of time.

Pain resulting from peripheral nerve and root lesions was well recognized and recorded during the earlier part of the 19th century. Silas Weir Mitchell's descriptions of pain following peripheral nerve trauma and, particularly, his detailed accounts of causalgia [11] in casualties …