J Korean Med Assoc.  2012 Jun;55(6):582-592. 10.5124/jkma.2012.55.6.582.

The pharmacological management of neuropathic pain

• Ko Y
• Kim YH

• KMID: 2015657
• DOI: http://doi.org/10.5124/jkma.2012.55.6.582

Abstract

Neuropathic pain has recently been defined as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system". Neuropathic pain is a debilitating chronic condition that remains very difficult to treat and challenging to manage. Tricyclic antidepressants (amitryptiline, nortriptyline, imipramine), selective serotonin and norepinephrine reuptake inhibitors (duloxetine, venlafaxine), anticonvulsants (gabapentin, pregabalin), and 5% lidocaine patches have demonstrated efficacy in neuropathic pain and are recommended as first-line medications. In patients who fail to respond to these first-line medications alone and/or in combination, opioid analgesics or tramadol can be used as a second-line treatment alone or in combination with one of the first-line medications. Opioid analgesics and tramadol can also be considered for first-line use in selected clinical circumstances. Other pharmacological therapeutic options include selective serotonin reuptake inhibitors, antiepileptic drugs (levetiracetam, lacosamide, lamotrigine, valproic acid), cannabinoids, high concentration capsaicin patch, and botulinum toxin A. Medication selection should be individualized, with side effects taken into consideration as well as potential beneficial or deleterious effects on comorbidities, and whether or not prompt onset of pain relief is necessary.

Keyword

Neuropathic pain; Pharmacologic management; Evidence-based recommendations

MeSH Terms

Acetamides
Analgesics, Opioid
Anticonvulsants
Antidepressive Agents, Tricyclic
Botulinum Toxins
Cannabinoids
Capsaicin
Comorbidity
Humans
Lidocaine
Neuralgia
Norepinephrine
Nortriptyline
Serotonin
Serotonin Uptake Inhibitors
Tramadol
Triazines
Acetamides
Analgesics, Opioid
Anticonvulsants
Antidepressive Agents, Tricyclic
Botulinum Toxins
Cannabinoids
Capsaicin
Lidocaine
Norepinephrine
Nortriptyline
Serotonin
Serotonin Uptake Inhibitors
Tramadol
Triazines

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