Neuropathic Pain

Question 1

Which two classes of drugs used in the treatment of neuropathic pain should be prescribed with additional precautions related to safety?

Answer 1

1. Anti-epileptic drugs

2. Opioids

Question 2

Neuropathic pain occurs as a result of damage to ____________?

Answer 2

Neural tissue

Question 3

What are the types of neuropathic pain? (7)

Answer 3

1. Phantom limb pain
2. Compression neuropathies
3. Peripheral neuropathies (eg DM, chronic excess alcohol, HIV, chemo, idiopathic)
4. Trauma
5. Central pain (eg pain following stroke, spinal cord injury, syringomyelia)
6. Post herpetic neuralgia (nerve damage following acute herpes zoster infection)
7. Trigeminal neuralgia (management distinct from other forms of neuropathic pain)

Question 4

What are some of the causes of peripheral neuropathy? (4)

Answer 4

1. DM complications
2. Chronic excessive alcohol intake
3. HIV infection
4. Chemotherapy

(Also idiopathic)

Question 5

What is allodynia?

Answer 5

pain that is evoked by a non-noxious stimulus

Question 6

Neuropathic pain is generally managed with a _______________ or with certain ___________ drugs

Answer 6

tricyclic antidepressant (amitriptyline, nortriptyline)

antiepileptic (pregabalin, gabapentin)

Question 7

Neuropathic pain may respond to opioid analgesics. There is evidence of efficacy for ________________, _____________, and ______________

Answer 7

tramadol hydrochloride

morphine

oxycodone hydrochloride

*tramadol can be prescribed while the patient is awaiting assessment by a specialist; however, treatment with morphine or oxycodone hydrochloride should be initiated only under specialist supervision

Question 8

Which opioid may be initiated without specialist supervision, while patients are awaiting specialist assessment for neuropathic pain?

Answer 8

Tramadol

Question 9

Patients with localised pain who are unable to take oral medicines may benefit from topical local anaesthetic preparations, such as __________-medicated plasters, while awaiting specialist review

Answer 9

lidocaine hydrochloride

Question 10

_____________ is licensed for neuropathic pain, but the intense burning sensation during initial treatment may limit use

Answer 10

Capsaicin

Question 11

____________ 0.075% cream is licensed for the symptomatic relief of postherpetic neuralgia

Answer 11

Capsaicin

Question 12

A self-adhesive patch containing __________ 8% is licensed for the treatment of peripheral neuropathic pain

Answer 12

capsaicin; should be used under specialist supervision.

Question 13

A ________________ may help to relieve pressure in compression neuropathy and thereby reduce pain.

Answer 13

corticosteroid

Question 14

_____________ by spinal cord stimulation may be of benefit in some patients with neuropathic pain

Answer 14

Neuromodulation

Question 15

Neuromodulation by ______________ may be of benefit in some patients with neuropathic pain

Answer 15

spinal cord stimulation

Question 16

Many patients with chronic neuropathic pain require multidisciplinary management, including ____________ and _____________ support

Answer 16

physiotherapy

psychological

Question 17

Surgery may be the treatment of choice in many patients with _______________ (neuropathic pain disorder)

Answer 17

trigeminal neuralgia

Question 18

__________ may be the treatment of choice in many patients with trigeminal neuralgia

Answer 18

Surgery

Question 19

____________ taken during the acute stages of trigeminal neuralgia, reduces the frequency and severity of attacks

Answer 19

Carbamazepine

Question 20

Carbamazepine taken during the acute stages of _____________, reduces the frequency and severity of attacks

Answer 20

trigeminal neuralgia

Question 21

____________ and ____________ should be monitored when high doses of carbamazepine are given for the treatment of trigeminal neuralgia

Answer 21

Blood counts

electrolytes

Question 22

Some cases of trigeminal neuralgia respond to ____________

Answer 22

Phenytoin

Question 23

What are the types of chronic facial pain? (2)

Answer 23

1. Persistent idiopathic facial pain (‘atypical facial pain’)
2. TMJ dysfunction (TMD)

Question 24

____________ may be useful in the treatment of chronic facial pain [unlicensed indication]

Answer 24

Tricyclic antidepressants

Question 25

How are patients with chronic facial pain managed?

Answer 25

Disorders of this type require specialist referral and psychological support to accompany drug treatment with TCAs. Patients on long-term therapy need to be monitored both for progress and for side-effects.

Question 26

_____________ and ____________ can be used in combination if a patient being treated for neuropathic pain has an inadequate response to either drug at the maximum tolerated dose

Answer 26

Amitriptyline hydrochloride

pregabalin

Question 27

What are topical options for the treatment of neuropathic pain? (2)

Answer 27

1. Lidocaine-medicated plasters

2. Capsaicin cream