Journal of Infectious Diseases & Therapy
Open Access

Abstract

Statement of the Problem Neuropathic Pain is a difficult pain entity to diagnose, calssify and treat. Diagnosis, especially with small fibre neuropathy is unsatisfactory and based on basic clinical signs and symptoms. First line treatments often include antineuropathics such as gabapentinoids and tricyclics which have a high NNT, with most imparting unacceptable side effects. Clinical Ptactice: At Kings College Hospital the Pain Management Department have teamed up with two peripheral neuropathy specialists to diagnose and form treatment plans for this group of patients. Diagnosis is done at Kings College London University using microneurography and skin biopsies for confirmation. Treatment plans are steered in a multimodal direction including avoidance of regular medications if possible. These include Capsaicin 8% patches (Qutenza), intravenous lidocaine and ketamine burst infusions and pulsed radiofrequency of relevant nerves using X-ray or ultrasound. Biospsychosocial assessment also allows recognition of psychosocial factors and treatment such as depression and anxiety. Conclusion & Significance Multispecialty assessment allows firm diagnosis and efficacious and tailor made treatment plans to be made for this difficult group of patients. Avoidance of regular antineuropathics is a key component, preventing development of side effects which decrease quality of life. Recent Publications Z Oon and A Woo Should thoracic epidurals be routinely sited in patients having cardiac surgery? British Journal of Hospital Medicine 2017 78:12, 730-730 Woo A and Sinha M. Should ultrasound or X-rays be used in chronic pain medicine interventions?. British Journal of Hospital Medicine 2016, 77(5), p. 314 Woo A, Tharakan L and Vargulescu R. Stellate Ganglion Block for Painful Congenital Venous Malformation of the Arm. Pain Practice 2015 Wilson J and Woo A Long term Opioids: Friend or Foe? British Journal of Hospital Medicine 74(5): 298 (May 2013 Woo A. Depression and Anxiety in Pain. British Journal of Pain March 2010 vol. 4 no. 1 8-12

Biography

Adam Woo is Consultant in Pain Management and Anaesthesia at Kings College Hospital. He is Fellow of the Royal College of Anaesthetist, Fellow of the Faculty of Pain Medicine. He has an MSc from Ediburgh University and trained in pain medicine at UCL Hospitals, St Thomas’ Pain Management Centre and Great Ormond Street Hospital. He is member of the Anghoff Committee for the Faculty of Pain Medicine Exams and Local Pain Medicine Educational Supervisor.