Preface

Understanding the rapid changes in the evaluation and management of peripheral neuropa‐ thies, as well as the complexity of their mechanism, is a mandatory requirement for the practitioner to optimize patient's care. The objective of this book is to update health care professionals on recent advances in the pathogenesis, diagnosis and treatment of peripheral neuropathy. This work was written by a group of clinicians and scientists with large exper‐ tise in the field. In the first chapter of section one, Dr Emily A Ramirez and collaborators reviewed the pathogenesis of neuropathic pain and identified the anatomical pathways and the molecular mechanism of neuropathic pain. They reviewed the interaction between the central and peripheral nervous system in chronic pain as well as its clinical assessment and treatment. In the second chapter of section one, Dr Chengyuan Li and collaborators re‐ viewed the pharmacological management of diabetic neuropathy. This was based on trans‐ lational research from animal models of diabetic peripheral neuropathy. In the third chapter of section one, Dr Sabatino Maione and collaborators reviewed the complex mechanisms of painful neuropathy involving the central and peripheral nervous system. Based on these mechanisms, they evaluated the use of cannabinoids and stem cells for the treatment of pe‐ ripheral neuropathy. Dr Mendoza and Dr Salgado reviewed the diagnosis and management of compressive neuropathies in the first chapter of section two. In the second chapter of this section, Dr Jáuregui-Renaud provided a comprehensive review on the role of Postural bal‐ ance in the evaluation of peripheral neuropathy. In the last chapter of section two, Dr Kan‐ bayashi and Dr Hosokawa reviewed the most recent advances in the pharmacotherapy of postherpetic neuralgia.

I dedicate this work to the memory of my father, for his enduring love and guidance throughout my career, he continued to serve as a source of inspiration. I extend my grati‐ tude to my mother for her love and affection. I am continuously indebted to my wife Sonia for her love, unconditional support and encouragement, without her help and sacrifice, this work would not have been possible. I am also grateful to my son Sami and my beautiful daughters Leila and Nora for their love and energy which continue to be a valuable source of inspiration.

#### **Dr Nizar Souayah**

Neuromuscular Medicine Program Director Director of Peripheral Neuropathy Center Department of Neurology and Neuroscience University of Medicine & Dentistry of New Jersey, USA

**Section 1**

**Peripheral Neuropathy: From Bench to Bedside**

**Peripheral Neuropathy: From Bench to Bedside**

**Chapter 1**

**Neuropathic Pain:**

http://dx.doi.org/10.5772/55277

**1. Introduction**

with chronic pain [13, 14].

Emily A. Ramirez, Charles L. Loprinzi, Anthony Windebank and Lauren E. Ta

Additional information is available at the end of the chapter

**From Mechanism to Clinical Application**

A lesion or disease affecting the somatosensory system can cause a wide range of pathophy‐ siologic symptoms including mild or severe chronic pain. Due to the diversity of etiologies giving rise to nervous system damage that generates neuropathic pain, it has become a ubiquitous health concern without respect for geographic or socioeconomic boundaries [1]. Within the developing world, infectious diseases [2-4] and trauma [5] are the most common sources of neuropathic pain syndromes. The developed world, in contrast, suffers more frequently from diabetic polyneuropathy (DPN) [6, 7], post herpetic neuralgia (PHN) from herpes zoster infections [8], and chemotherapy-induced peripheral neuropathy (CIPN) [9, 10]. There is relatively little epidemiological data regarding the prevalence of neuropathic pain within the general population, but a few estimates suggest it is around 7-8% [11, 12]. Despite the widespread occurrence of neuropathic pain, treatment options are limited and often ineffective, leaving many to live with the persistent agony and psychosocial burden associated

Neuropathic pain can present as on-going or spontaneous discomfort that occurs in the absence of any observable stimulus or a painful hypersensitivity to temperature and touch. This limits physical capabilities and impairs emotional well-being, often interfering with an individual's ability to earn a living or maintain healthy relationships. It is not surprising, therefore, that people with chronic pain have increased incidence of anxiety and depression and reduced

Despite significant progress in chronic and neuropathic pain research, which has led to the discovery of several efficacious treatments in rodent models, pain management in humans

and reproduction in any medium, provided the original work is properly cited.

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© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

scores in quantitative measures of health related quality of life [15].
