neuropathic pain

Question 1

how does it occur

Answer 1

as a result of damage to neural tissue
pain may occur in an area of sensory deficit and is sometimes accompanied by pain that is evokes by a non noxious stimulus (allodynia)

Question 2

how is it generally managed?

Answer 2

a TCA or certain AEDs
amitriptyline and pregabalin are effective treatments
they can be used in combination if pt has inadequate response to either drug at max tolerated dose
gaba also effective

Question 3

…. may be better tolerated than amitriptyline

Answer 3

nortriptyline
unlicensed

Question 4

does it respond to opioids?

Answer 4

it may - evidence of efficacy for tramadol, morphine and oxycodone
morphine and oxycodone: imitate under specialist supervision
tramadol can be prescribed when other treatments have been unsuccessful, while pt is waiting for assessment by specialist

Question 5

localised pain and unable to take oral meds - may benefit from

Answer 5

topical LA preps e.g. lidocaine medicated plasters, while awaiting specialist review

Question 6

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

Answer 6

capsaicin

Question 7

this may help to relieve pressure in compression neuropathy and thereby reduce pain

Answer 7

a CC

Question 8

what is trigeminal neuralgia

Answer 8

sudden severe facial pain
sharp shooting pain or having electric shock in ja, teeth or gums
usually happens in short unpredictable attacks that can last from a few seconds to about 2 mins

Question 9

what is trigeminal neuralgia caused by

Answer 9

compression of trigeminal nerve

Question 10

treatment for trigeminal neuralgia

Answer 10

surgery may be treatment of choice in many pt - do neurological assessment to see hwo
carbamazepine taken during acute stages reduces freq and severity of attacks

Question 11

discuss the use of carbamazepine for trigeminal neuralgia

Answer 11

• if taken during acute stages it reduces free and severity of attacks
• very effective for severe pain associated with it
• if high doses given, blood counts and electrolytes need to be monitored
• use small doses initially to reduce incidence of SE e.g dizziness

Question 12

carbamazepine can be used for trigeminal neuralgia. some cases may respond to this other AED

Answer 12

phenytoin
can be given IV (possible as fosphenytoin) in a crisis - specialist use only

Question 13

what may be useful for chronic facial pain

Answer 13

TCAs