Guidelines for treatment of Neuropathic Pain

20th September 2007 at 16:51 BST by Dr C.A.Jenner MB BS, FRCA. Permalink.

This article gives the guidelines for treatment of neuropathic pain.

Guidelines for treatment of Neuropathic Pain

Introduction

Neuropathic pain is a complex, chronic pain state, typically characterized by a burning and shooting pain, along with a feeling of tingling and numbness. The International Association for the Study of Pain (IASP) defines neuropathic pain as a pain which arises from the inflammation of or injury to the peripheral or central nervous system or from the dysfunction of the nervous system. Research indicates that almost 8% of the total population suffers from neuropathic pain in the UK.

Treatment – Underlying Principles

There are two main underlying principles that form the basis for a successful treatment plan for managing neuropathic pain. These are:

1. The key aim is to attend to the underlying causative condition, which is central to the neuropathic pain management.
2. Conservative treatment is generally the first and preferred mode of treatment, supplemented by suitable alternative therapies.

The treatment options available for gaining relief from neuropathic pain can be primarily discussed under two main categories .i.e. the pharmacological measures and the non-pharmacological measures. In the further sections, we've discussed each of these treatment options, with relevant details.

Pharmacological Measures

Here we've given a brief outline of the most important non-pharmacological measures adopted for the neuropathic pain management.

a) Non-opioid analgesics

NSAIDs and non-opioid analgesics have proven to be highly effective in cases like diabetic neuropathy. However, there are specific side effects associated with NSAIDs and adequate medical intervention should be sought before the using these medicines.

b) Tricyclic antidepressants

One of the most commonly used tricyclic antidepressants is amitriptyline, given with an initial dose of 10-25 mg. The dosage can be further increased gradually, going up to 75 mg a day.

c) Anti-convulsants

Anti-convulsants such as gabapentin and pregabalin have been found to be highly effective for the treatment of neuropathic pain. While gabapentin is normally prescribed for 1800-3600 mg a day, pregabalin is generally prescribed at 100-600 mg day.

d) Opioids

Opioids generally prove useful where other medications fail to produce the desired effect. Medications such as tramadol and oxycodon have especially been found to be quite useful.

e) Topical creams

Creams like capsaicin, when applied three to four times a day have proven to be quite effective in obtaining relief from neuropathic pain. In addition, medications like antiarrhythmic drugs and specialized treatments like lidocaine, intrathecal injections and nerve blocking techniques are also used as a part of the pharmacologic treatment for neuropathic pain management.

Non-Pharmacological Measures

Non-pharmacologic measures are generally advised as the initial line of treatment for neuropathic pain management, failing which the pharmacologic measures are adopted. Here we've briefly discussed the main non-pharmacologic measures involved.

a) Electrical stimulation

Transcutaneous electrical stimulation (TENS) is a process in which an electronic device that produces electrical signals in order to stimulate nerves through unbroken skin.

b) Acupuncture

Acupuncture is a highly effective alternative form of therapy and has produced positive results in the treatment of neuropathic pain. In addition, research also indicates that percutaneous nerve stimulation (PENS), which is a basically a combination of acupuncture and TENS to be an effective form of neuropathic pain management option.

c) Patient Education

This measure basically involves educating the patient about his/her specific conditions, causes and possible methods of relief. Other forms of non-pharmacologic measures include:

• Psychological counseling
• Exercise
• Lifestyle modifications
• Cessation in smoking
• Maintaining a healthy diet

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