The Assessment and Management of Neuropathic Pain in Primary Care and Resource-limited Setting: The Indonesian Perspective

Abstract

Neuropathic pain (NP) is a common pain condition worldwide that originates in the peripheral or central nervous system. In Indonesia, it has received little attention, as evidenced by limited national data and drug distribution. Policies on referral systems have been established for a long time, but are inefficient. NP is challenging for primary care physicians (PCPs) to manage because of the heterogeneity of its etiologies and limited resources. The clinical approach in NP includes identifying and exploring the body area involved, bedside neurological examinations, evaluation using assessment tools, pain management, and referral. Pharmacological therapy using first-line drugs can be evaluated for its efficacy and side effects every three to eight weeks. Non-pharmacological therapy can be initiated early to address psychological issues that worsen pain experience. A multidisciplinary approach combining pharmacological interventions with physical or cognitive interventions is critical in the treatment of NP. Pain neuroscience education, counseling, self-management, and breathing-relaxation techniques yielded promising results. In several cases, a referral to a specialist may be necessary.