Neuropathic pain — master index¶
Last curated: 2026-10-21 · status: audited 2026-08-30; 8 pages edited by the 2026-09-30 literature sweep and demoted to draft pending independent audit; 4 of those 8 edited again by the 2026-10-21 sweep
The condition in five sentences. Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system, graded as possible, probable or definite according to history, neuroanatomy, sensory signs and confirmatory evidence (Finnerup 2016, PMID 27115670). Population studies suggest 6.9–10% prevalence when validated screening instruments are used, though case ascertainment varies (van Hecke 2014, PMID 24291734). Ectopic activity, altered ion channels, neuroimmune signaling, disinhibition and central sensitization produce heterogeneous combinations of burning, electric-shock pain, allodynia, numbness and evoked pain (Colloca 2017, PMID 28205574; Finnerup 2021, PMID 32584191). First-line medicines—tricyclic antidepressants, SNRIs, gabapentin and pregabalin—help only a minority, and topical therapies are useful for selected peripheral phenotypes (Finnerup 2015, PMID 25575710). The frontier is mechanism-based phenotyping and combination or neuromodulation strategies that improve modest responder rates without importing opioid or device harms (Petersen 2021, PMID 33818600).
Start here: overview.md. Diagnostic path: definition, grading and diagnosis → sensory phenotyping → biomarkers. Treatment path: pharmacology → topical/interventional → neuromodulation. Etiology path: diabetes, postherpetic/postsurgical, chemotherapy/toxic, and central pain. Frontier: OPEN-QUESTIONS.md.
Pages¶
| File | Scope | Status |
|---|---|---|
| overview.md | Definition, burden, mechanisms, phenotypes and treatment map | curated |
| definition-grading-and-diagnosis.md | Possible/probable/definite grading, examination and confirmatory tests | draft |
| epidemiology-and-burden.md | Population prevalence, disability and condition-specific burden | draft |
| peripheral-mechanisms.md | Ectopic firing, channels, neuroma, small fibers and immune interactions | curated |
| central-sensitization-and-plasticity.md | Spinal/cortical amplification, disinhibition and maintained pain | curated |
| sensory-phenotyping-and-qst.md | Bedside signs, QST, clusters and mechanism inference | curated |
| diabetic-neuropathic-pain.md | Distal symmetric neuropathy, metabolic injury and treatment | draft |
| postherpetic-and-postsurgical-pain.md | PHN, nerve injury, prevention and localized therapy | draft |
| chemotherapy-and-toxic-neuropathy.md | CIPN prevention, treatment and survivorship | draft |
| spinal-cord-and-central-neuropathic-pain.md | SCI, stroke, MS and central phenotypes | curated |
| pharmacologic-treatment.md | Antidepressants, gabapentinoids, sodium-channel drugs and combinations | curated |
| topical-and-interventional-treatment.md | Lidocaine, capsaicin, blocks, ablation and selection | curated |
| neuromodulation.md | SCS, DRG stimulation, non-invasive approaches and durability | draft |
| guidelines.md | NeuPSIG, EAN/EFIC and national recommendations | draft |
| biomarkers.md | QST, skin biopsy, imaging, electrophysiology and molecular candidates | curated |
| clinical-trials-landscape.md | Drugs, combinations, devices and mechanism-stratified trials | draft |
| patient-experience-and-advocacy.md | Sleep, function, disbelief, access and patient priorities | curated |
| red-flags-and-safety-concerns.md | Progressive deficit, myelopathy, cauda equina, toxicity and medication harms | curated |
Literature layer¶
| Artifact | Status |
|---|---|
| Bibliography | 349 unique live-resolved PMIDs: 309 audited 2026-08-30, 20 added by the 2026-09-30 sweep and 20 by the 2026-10-21 sweep (both awaiting audit) |
| Landmark notes | 6 notes |
| Guideline registry | deepened; >25 international/national documents and explicit disagreement map; NeuPSIG 2025 revision registered 2026-09-30 |
| Statistics | deepened; conflicting estimates, effect sizes and confidence intervals retained side by side; 24 rows added 2026-09-30 and 12 on 2026-10-21 (awaiting audit) |
| Patient voice | audited; organization URLs rechecked 2026-10-21 (3 of 6 reachable by automated request; 3 returned 403/500); one trigeminal-neuralgia source added 2026-10-21 |
Curation state¶
This condition was audited on 2026-08-30, when all 18 canonical pages passed the separate claim-to-source review. The 2026-09-30 periodic literature sweep edited eight pages—definition and grading, epidemiology, diabetic pain, postherpetic/postsurgical pain, chemotherapy neuropathy, neuromodulation, guidelines and clinical trials—and demoted them to draft; the other ten remain curated. Every page remains within the 150–400-line target and carries 28–34 live-resolved PMID references. The trial landscape contains 22 NCT records re-fetched live on 2026-09-30 (16 previously tracked, 6 added), and the condition bibliography contains 329 unique PMIDs. One verification flag is open: the content of a published comment in the 2026 grading debate (PMID 42708623) is reported only as relayed in the reply and is marked [unverified] on the definition page. An independent audit by a different engine is required before the eight pages are re-promoted. The 2026-10-21 sweep edited four of those already-draft pages—chemotherapy (CryoPac null cryotherapy RCT, reduced-oxaliplatin-exposure meta-analysis, glutathione network meta-analysis, a missed-primary duloxetine/venlafaxine RCT, a negative pNF-H biomarker study and a 901-person risk-factor study), postherpetic/postsurgical (zoster-vaccine PHN effectiveness in immune-mediated disease; IV-lidocaine prevention meta-analysis), diabetic pain (crisugabalin versus pregabalin phase 2) and the trials landscape (22 NCT records re-fetched; one completion date moved)—and touched no curated page. The trial landscape now also notes CryoPac's stale registry record (NCT05928429).