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Neuropathic pain is caused by damage to the parts of the nervous system that normally signal pain. Attempts to classify neuropathic pain patients on the basis of disease etiology or lesion topography have met with limited success, and in this review Ralf Baron presents an alternative system based on molecular mechanisms. He discusses how this approach might lead to the development of more rational treatments for neuropathic pain.

Since the launch ofNature Clinical Practice Neurologyin 2005, we have seen remarkable progress in many areas of neurology research, but what does the future hold? For this special Viewpoint article, we invited a panel of Advisory Board members and other journal contributors to outline their research priorities and predictions for the next 10 years.

This Case Study describes a 64-year-old woman who presented with a 2-year history of itch on her right dorsal forearm. The patient was diagnosed with brachioradial pruritus caused by cervical disc herniation, and the symptoms resolved after surgery to decompress the sixth cervical nerve root. Various alternative treatment options for brachioradial pruritus are discussed.

Successfully treating chronic pain is challenging, as patients respond heterogeneously to analgesic treatments. Such variation in response can be attributed to differing underlying pain-generating mechanisms. A novel clinical bedside test that identifies distinct pain phenotypes might help deliver more-effective mechanism-based treatment strategies.

The most common symptom of osteoarthritis is pain, but current treatments do not identify or treat different types of osteoarthritis-associated pain. In this Opinion article the authors argue that some patients with osteoarthritis have neuropathic pain, and that analgesic drugs generally prescribed for neuropathic pain that is unrelated to osteoarthritis should also be used to treat this subset of patients.

Itch is a common symptom of inflammatory skin disorders, but it can also occur as a result of damage to the itch-mediating nervous system, in which case it is known as neuropathic itch. In this Review, Binder et al. describe the mechanisms underlying itch generation, introduce a classification system for itch, and propose a mechanism-based management approach to chronic neuropathic itch. The topic of neuropathic itch is explored further in an accompanying Case Study in this issue.

In complex regional pain syndromes (CRPS), pain—typically of neuropathic type—in the affected limb is accompanied by a variety of sensory, motor and autonomic signs and symptoms. Treatment for CRPS has been largely adapted from therapies for neuropathic pain states, but a better understanding of CRPS pathologenesis might provide opportunities for mechanism-based treatment. Here, the authors discuss available and emerging mechanism-based treatments in CRPS, including pharmacotherapy targeting central and peripheral sensitization and aberrant inflammatory response; sympathetic ganglion block interventions; and alleviation of symptoms by reversing body perception disturbances.

Chemotherapy-induced peripheral neuropathic pain (CIPNP) is a common and severe adverse effect of cytostatic drugs that can limit dose and choice of chemotherapy, and can lead to delay or discontinuation of cytostatic treatment. Most drugs that are in use for neuropathic pain have failed to alleviate CIPNP in clinical trials. Here, Sisignano et al. review the mechanisms through which the most commonly used cytostatic drugs cause CIPNP, and suggest mechanism-based treatment options.