There has been a wealth of research into what causes pain. It is a symptom or warning of an underlying medical problem. Researchers can describe in detail how the sensation is transmitted from its source to the brain so we become aware of the problem and can take action to treat it. Unfortunately, despite our better understanding of what it is, actually relieving the pain remains a challenge. If we are dealing with a non-fatal physical injury, we can set the broken bones, stitch up the wounds and wait for the body to repair itself. During this time, the pain management choices for doctors focus on the various side effects of the medications, the interactions between medications, etc. If the pain becomes more acute due to a terminal condition, the issues of addiction and, to some extent, adverse side effects are less relevant. The humanitarian need is to make a person as comfortable as possible during the final period of life. But long-term neuropathic pain represents a completely different set of challenges.



Neuropathic pain is not properly understood and, consequently, not routinely diagnosed. It is caused by a lesion or dysfunction to the peripheral or central nervous system, i.e. the nervous system itself is damaged. The cause may be a physical injury or a disease may affect the way it works. Consequently, the pain may be caused by the damage to the nervous system itself or the system may be sending out general distress symptoms or, in some cases, false pain messages. Physical injuries to the nervous system are very difficult to treat because nerve tissue does not easily regenerate. In other cases, researchers do not properly understand why an apparently undamaged system may malfunction. Because the system that transmits and controls pain sensations may be damaged or not working properly, people often react to treatment in a wide variety of unpredictable ways. For the same reason, many prove more vulnerable than usual to adverse side effects. But the consequences of not providing effective pain relief can be serious. People who experience pain over a longer period of time are more likely to become depressed and may find it difficult to remain in paid work.

One of the main difficulties in treating neuropathic pain is that the usual opioid analgesics do not work well. Consequently, it can take longer for the medication to reach a stable and effective level in the blood stream. During the slow build up of the drug, people can become discouraged and either want to switch to another drug thought better or discontinue use of the immediate drug. In clinical trials of the opioids, more than a quarter of participants withdrew because of the physical and psychological side effects. This is unfortunate because it usually takes between four and six weeks for doctors to be able to assess the effectiveness of the chosen opioid.

But is an atypical opioid and its ability to relieve pain of all kinds makes it one of the first-response medications for the treatment of neuropathic pain. Doctors must, of course, take care to avoid adverse interactions with other medications, particularly the two classes of antidepressants: the Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MOIs). The other most common problem is that anyone with a history of seizures or who is being treated with medications that lower the seizure threshold may be at an increased risk of seizures if they are taking ultram. However, ultram is generally preferred in cases of neuropathic pain because there are fewer problems of dependence so long as people use the medication as prescribed. In other words, the balance of advantages against disadvantages usually supports the use of ultram for the treatment of neuropathic pain.