Neuropathic pain: Difference between revisions
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==Management== | ==Management== | ||
*Do not consider starting pts on medications unless they will definitely obtain good followup | *Do not consider starting pts on medications unless they will definitely obtain good followup | ||
*First line medication options (all have NNT from ~2-3) | *First line medication options (all have NNT from ~2-3 or better) | ||
**AEDs - gabapentin, topiramate | **AEDs - gabapentin, topiramate | ||
**TCAs - amitryptyline, nortriptyline | **TCAs - amitryptyline, nortriptyline | ||
Revision as of 04:08, 22 November 2014
Background
- Neuropathic pain responds best to neuropathic meds - not to opiates
- If opiates can be avoided, it helps PCPs and pain management specialists create a better regimen
- Cornerstone of pain management is activity (exercise, PT, aquatherapy), but opiates/benzodiazepines restrict this
Management
- Do not consider starting pts on medications unless they will definitely obtain good followup
- First line medication options (all have NNT from ~2-3 or better)
- AEDs - gabapentin, topiramate
- TCAs - amitryptyline, nortriptyline
- Pregabalin
- NSAIDs and tylenol
- Second line medications (temporary relief, not long term)
- Tramadol
- Muscle relaxants - cyclobenzaprine, methocarbamol, diazepam
- Refer to pain specialist for multidisciplinary approach
References
Rathmell JP. A 50-year-old man with chronic low back pain. JAMA. 2008;299(17):2066-77.