Neuropathic pain management

Brau ME et al Effect of drugs used for neuropathic pain management on tetrodotoxin-resistant Na+ currents in rat sensory neurons. Anesthesiology 2001 94 137. [PMID 11135733]... 

It is an empirical decision whether to start with duloxetine or anti-epileptics for neuropathic pain management. Vigilant follow-up and patient education on drug-drug interactions are crucial to a successful launch of duloxetine. It is prudent to start with a low dose (20-30 mg) of duloxetine and titrate cautiously to balance the risk and benefit ratio. Duloxetine doses higher than 60 mg failed to provide any additional pain relief yet caused more adverse events and withdrawals according to previous clinical studies. 

Verma S, Estanislao L et al (2005) HIV-associated neuropathic pain epidemiology, pathophysiology and management. CNS Drugs 19(4) 325-334 ViUa A, Forest V et al (1987) Autonomic neuropathy and HIV infection. Lancet 2(8564) 915... 

Diabetic peripheral neuropathic (DPN) pain For the management of neuropathic pain associated with DPN. 

In addition to its use for the management of epilepsy and neuropathic pain, carbamazepine is employed for the treatment of manic depression (for review see Elphick, 1989). 

Lamotrigine, which has been shown to be effective in several neuropathic pain conditions, offers an alternative approach to carbamazepine for the management of trigeminal neuralgia... 

Sloan, P., Basta, M., Storey, P., Gunten, von, C. Mexilitine as an adjuvant analgesic for the management of neuropathic pain, Anesth. Analg. 1999, 89, 760-761. 

Compounds with moderate p-affinities are very potent in a variety of pain models in mice and rats. In addition to antinociceptive efficacy in models of acute pain (tail flick, writhing) these compounds inhibit acute and persistent inflammatory pain (Randall Selitto, formalin test). Furthermore, they show strong inhibition of acute visceral pain (colorectal distension) and of tactile and cold allodynia in models of neuropathic pain (spinal nerve ligation (Chung), chronic constriction injury (Bennett)). The data suggest these compounds to be potential candidates for the management of clinical pain indications. Somatic and visceral pain with and without inflammatory conditions as well as neuropathic pain might be addressed with this approach. 

Crosby, V., Wilcock, A., Corcoran, R. The safety and efficacy of a single dose (500 mg or 1 g) of intraveneous magnesium sulfate in neuropathic pain poorly responsive to strong opioid analgesics in patients with cancer, J. Pain Symptom Manage. 2000, 19, 35-39. 

Stringer, M., Makin, M. K., Miles, J., Morley, J. S. D-Morphine, but not L-morphine, has low micromolar affinity for the non-competitive N-methyl-D-aspartate site in rat forebrain. Possible clinical implications for the management of neuropathic pain, Neurosci. Lett. 2000, 295, 21-24. 

Stacey BR. Management of peripheral neuropathic pain. AmJPhysMedRehabil. 2005 84(suppl) S4-S16. 

Neuropathic pain follows damage to the nervous system. Acute pain without nociceptive (afferent) input (some neuralgias) is less susceptible to drugs unless consciousness is also depressed, and any frequently recurrent acute pain, e.g. trigeminal neuralgia, poses management problems that are more akin to chronic pain. 

Woolf C J, Mannion R J 1999 Neuropathic pain aetiology, symptoms, mechanisms, and management. Lancet 353 1959-1964... 

Chronic pain patients tend to have concurrent depression however, the antidepressants chosen may not have any pain-relieving properties. Antidepressants that affect one neurotransmitter in the brain, such as selective serotonin reuptake inhibitors have not appeared to be effective in the management of pain in clinical trials. Antidepressants that affect multiple neurotransmitters— namely, serotonin and norepinephrine—have been shown to be effective pain relievers.Two published metaanalyses have shown that tricyclic antidepressants amitriptyline, desipramine, imipramine, and nortriptyline are the most effective treatment for the management of neuropathic pain. ° These publications review the published clinical trial data for all agents available for the management of neuropathic pain. 

Pharmacists in ambulatory settings may work in chronic pain clinics as part of the treatment team. These clinicians perform extensive medication reviews and provide alternatives when treatments fail. Pharmacists who work with diabetic patients may be responsible for managing neuropathic pain. 

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