Actualización en Neuropatías Craneofaciales y Periféricas: De la Taxonomía CIE-11 a la Medicina de Precisión

Background: Neuropathic pain represents a growing global burden and has been selected by the IASP as the Global Year Topic for 2026. The implementation of the ICD-11 has redefined chronic pain taxonomy (MG30), necessitating an update in the clinical management of the most prevalent neuropathies. Objective: To synthesize recent updates regarding definitions, diagnostic criteria, molecular pathophysiology, and pharmacological and interventional treatment for Trigeminal Neuralgia (TN), Persistent Idiopathic Facial Pain (PIFP), Postherpetic Neuralgia (PHN), and Painful Diabetic Neuropathy (PDN). Methods: A structured literature review was conducted using PubMed, Cochrane, Embase, and Scielo databases. Clinical guidelines (EAN, IASP, ADA) and recent meta-analyses were analyzed to establish levels of evidence, NNT (Number Needed to Treat), and NNH (Number Needed to Harm). Results: TN classification is evolving towards an MRI-based stratification, while maintaining sodium channel blockers as the Gold Standard (NNT 1.7). The term "Atypical Facial Pain" is being abandoned in favor of PIFP, emphasizing central sensitization mechanisms. For PDN and PHN, sensory phenotyping is prioritized to distinguish between "irritable nociceptor" versus "deafferentation" profiles, guiding the use of gabapentinoids, dual inhibitors (SNRIs), and high-concentration topical therapies (8% capsaicin). Conclusions: Contemporary management is transitioning from a purely etiology-based approach to a mechanism-based approach (precision medicine). The implementation of the ICD-11 and clinical phenotyping are essential to optimize therapeutic efficacy.