22 - Neuropathic Pain Flashcards
non-pharms
- physiotherapy, mindfulness, yoga, exercise, psychotherapy, ensure enough sleep
- evidence is lacking for these but provide no harm
A trial of ____ months is reasonable
2-3 months
meds for acute phase for nerve root compression?
NSAIDs or acetaminophen may be effective
1st line for chronic peripheral neuropathic pain
TCAs, gabapentinoids, SNRIs
2nd line for chronic peripheral neuropathic pain
tramadol and topical lidocane
When should you do a follow-up after starting meds for neuropathic pain?
1-2 weeks (to assess tolerability and s/e)
3rd line for chronic peripheral neuropathic pain
opioids (morphine, hydromorphone, oxycodone, transdermal fentanyl patch)
____ is an opioid that is a poor choice for any pain
codeine
Products with codeine or tramadol not for kids < ___ years old
12
4th line for chronic peripheral neuropathic pain
cannabinoids, methaodne tapentadol, lamotrigine, topiramate and botox
Risk factors for reactivation of VZV?
> 50 yo and decreased immunologic competence
Oral antivirals are most effective if started within ___ hours of the onset of the rash or severe pain
72
Options for acute pain of PHN?
amitriptyline and/or gabapentin and if necessary, opioids or nerve blocks
corticosteroids may improve QOL but does not accelerate healing so use them sparingly - not indicated for elderly, immunosuppressed, patients with DM, HTN, or GI ulcer
Trigeminal neuralgia is confined to the ____
face
*almost always unilateral
Trigeminal neuralgia usually responds to what drug?
Carbamazepine - measuring levels is not necessary but may be helpful to assess adherence or concerns regarding toxicity
if CBZ doesn’t work for trigeminal neuralgia, what is the next option?
oxcarbazepine
table 4 on page 347 has really good review
ok
Options for neuropathic pain in pregnancy?
- TCAs
- SNRIs
- topical lidocaine
- clonazepam prob safe but other spots say to avoid BZD in pregnancy
- opioids are safe but monitor baby once born
Can you use CBZ or oxcarbazepine in pregnancy?
- CBZ can cause neural tube defects
- they are unsure about oxcarbazepine
If person is using CBZ or oscarbazepine in pregnancy, what must they supplement with?
folic acid
Most of these drugs mentioned are ok for breastfeeding. Which ones are not recommended?
- chronic BZD not recommended if breastfeeding
- avoid pregabalin until we get more data
- don’t recommend codeine
Gabapentinoids need dose adjusment if CrCl < ___
60 mL/min
Venlafaxine need dose adjusment if CrCl < ___
70 mL/min
