Pregabalin, a new drug in the field of neuropathic pain treatment

Prof. Nicholson presented information on neuropathic pain, stating that pain is tissue damage or an unpleasant sensory and emotional experience described in terms of injury. Pain can be categorized into acute and chronic pain based on the course of the disease, and also into injury-perceived pain, neuropathic pain, and mixed pain based on the pathophysiology. Among them, neuropathic pain is pain caused by injury, lesion or dysfunction of the peripheral or central nervous system, which can be categorized into central and peripheral neuropathic pain, and can be caused by a variety of reasons such as metabolic abnormality, trauma, ischemia, intoxication, genetic factors, infections, compression, and immune abnormalities. A variety of mechanisms can lead to central and peripheral neuropathic pain. Peripheral mechanisms include increased cell membrane excitability and peripheral sensitization; central mechanisms include increased cell membrane excitability, uplift phenomenon, central sensitization, denervation hypersensitivity phenomenon, and absence of normal inhibition. Calcium channels play an important role in the excitatory process of neuronal cell membranes, which can cause nociceptive hypersensitivity and abnormal pain. After nerve injury, abnormal excitation of neurons leads to abnormal opening of calcium channels and massive inward flow of calcium ions, resulting in pain. The prevalence of neuropathic pain is high. 20% to 24% of diabetic patients have diabetic peripheral neuralgia; 25% to 50% of patients with herpes zoster over the age of 50 years develop postherpetic neuralgia (PHN) 3 months after the rash has healed; postoperative neuralgia exists in as many as 20% of patients who have had a mastectomy; and one-third of all cancer patients suffer from neuropathic pain (with or without injury-perceived pain). Therefore, the treatment of neuropathic pain needs to be urgently addressed. PHN is a typical peripheral neuropathic pain, the incidence of which increases with age . With the aging of society, the incidence of PHN is increasing year by year. Compared with injurious pain and inflammatory pain, PHN pain is more intense and has a great impact on the quality of life of patients. Most patients may suffer from anxiety and depression, as well as insomnia, anorexia, and loss of energy. Prof. Nicholson pointed out that medication is a common treatment for neuropathic pain. With the depth of a large number of basic and clinical studies, there are relatively well-established first-, second- and third-line therapeutic drugs. Currently, the commonly used therapeutic drugs for neuropathic pain mainly include calcium channel modulators (pregabalin), antidepressants, opioids, and topical skin medications.