Neuropathic pain (NP), comprising a range of heterogeneous pathophysiological conditions, is often difficult to manage despite a number of treatment guidelines have been published worldwide. Most of the available treatments in these guidelines have moderate efficacy and present side effects that limit their use. Currently, there is a general agreement on appropriate first-line treatment of NP, whereas debate continues regarding second- and third-line treatments. First-line drugs include antidepressants (tricyclic antidepressants (TCAs) and serotonin–noradrenaline reuptake inhibitors (SNRIs)) and gabapentinoids. Second- and third-line drugs for NP include topical lidocaine, topical capsaicin, anticonvulsants, and opioids. A good understanding of pathophysiology of NP with the mechanism of action of currently available drugs along with their side effect profile helps to tailor therapies both to the specific neuropathic disease and to the needs of an individual patient. This review provides an overview of current drugs available for the treatment of NP with an emphasis on their mechanism of action.
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