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This paper reviews the available literature on the role of neuropathic mechanisms in chronic <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> and discusses implications for its clinical management, with a particular focus on pharmacological treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Databases and data treatment<\/jats:title><jats:p>Literature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Chronic <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> comprises both nociceptive and neuropathic components, however, the neuropathic component appears under\u2010recognized and undertreated. Neuropathic pain (<jats:styled-content style=\"fixed-case\">NP<\/jats:styled-content>) is challenging to manage. Many patients with chronic <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s, although widely used for <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content>, are unlikely to ameliorate the neuropathic component and data on the use of <jats:styled-content style=\"fixed-case\">NP<\/jats:styled-content> medications such as antidepressants and gabapentin\/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content>, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral <jats:styled-content style=\"fixed-case\">NP<\/jats:styled-content>, may be a valuable additional approach for the management of neuropathic <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Chronic <jats:styled-content style=\"fixed-case\">LBP<\/jats:styled-content> often has an under\u2010recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>What does this review add?<\/jats:title><jats:p>Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism\u2010based therapies.<\/jats:p><jats:p>Open and retrospective studies suggest that agents like tapentadol and topical analgesics \u2014 such as the capsaicin 8% patch and the lidocaine 5% medicated plaster \u2014 may be effective options for the treatment of neuropathic low back pain in defined patient groups.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.838","type":"journal-article","created":{"date-parts":[[2016,3,3]],"date-time":"2016-03-03T04:21:42Z","timestamp":1456978902000},"page":"861-873","source":"Crossref","is-referenced-by-count":207,"title":["Neuropathic low back pain in clinical practice"],"prefix":"10.1002","volume":"20","author":[{"given":"R.","family":"Baron","sequence":"first","affiliation":[{"name":"Division of Neurological Pain Research and Therapy Department of Neurology University Hospital Schleswig\u2010Holstein Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Binder","sequence":"additional","affiliation":[{"name":"Division of Neurological Pain Research and Therapy Department of Neurology University Hospital Schleswig\u2010Holstein Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Attal","sequence":"additional","affiliation":[{"name":"INSERM U 987 and Centre d'Evaluation et de Traitement De La Douleur APHP Boulogne\u2010Billancourt France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Casale","sequence":"additional","affiliation":[{"name":"Habilita Care &amp; 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