Current Nonopioid Small Molecule Approaches Toward the Treatment of Neuropathic Pain

Chronic pain affects approximately 51.6 million adults annually in the United States, with 30-40% exhibiting symptoms consistent with neuropathic pain. Despite its prevalence and socioeconomic burden, effective pharmacological management of neuropathic pain remains limited. Current treatments often show inadequate efficacy, and many patients are refractory to available analgesics. Additionally, these agents are commonly associated with dose-limiting side effects and risks of tolerance, dependence, and abuse. The therapeutic gap has contributed to the overuse of opioids, exacerbating the opioid epidemic and increasing morbidity and mortality rates. There is a critical need to develop novel, nonaddictive analgesics that provide effective pain relief without engaging opioid pathways. Advances in the understanding of neuropathic pain mechanisms have identified alternative molecular targets, offering promising new directions for therapy. This Perspective highlights emerging pharmacological strategies, recent drug discovery efforts, and clinical developments aimed at delivering safer, more effective nonopioid treatments for neuropathic pain.