Neuropathic pain

Revision as of 04:08, 22 November 2014 by Kxl328 (talk | contribs)

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.

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