NEUROPHYSIOLOGICAL MECHANISMS AND PHYSIOTHERAPEUTIC STRATEGIES IN THE MANAGEMENT OF CHRONIC NEUROPATHIC PAIN: EMERGING CLINICAL EVIDENCE

Abstract

Chronic neuropathic pain is a complex, disabling condition that is caused by lesions or diseases of the somatosensory nervous system. It is sustained by peripheral nerve dysfunction, ectopic activity, dysregulated ion channels, neuroimmune dysfunction, central sensitization, maladaptive brain network function and neuroplasticity. Current pharmacologic treatments may not adequately relieve symptoms, underscoring the need for comprehensive, mechanism-targeted rehabilitation strategies. This review summarizes current evidence on the neurophysiological mechanisms underlying chronic neuropathic pain and examines physiotherapeutic interventions that may modulate these mechanisms. Therapeutic exercise, pain neuroscience education, manual therapy, neuromuscular re-education, mirror therapy, graded motor imagery, electrotherapy, neuromodulation, and virtual reality-based rehabilitation are discussed in relation to pain modulation, functional recovery, and patient-centered outcomes. Emerging clinical evidence supports the use of personalized rehabilitation approaches guided by pain phenotype, functional impairment, and neurophysiological profiles. Future directions include biomarker-guided rehabilitation, artificial intelligence-based prediction models, digital health integration, and standardized outcome assessment. A mechanism-based physiotherapy framework may improve treatment precision, enhance functional outcomes, and support long-term management of chronic neuropathic pain.