Neuropathic pain

Question 1

which drugs are generally used in the management of neuropathic pain?

Answer 1

1) Amitriptyline and pregabalin are effective treatments for neuropathic pain. Can be used in combination if the patient has an inadequate response to either drug at the maximum tolerated dose
2) Nortriptyline better tolerated than amitriptyline, Gabapentin is also effective

Question 2

Neuropathic pain may respond to opioid analgesics. which opioids have been shown to be useful?

Answer 2

1) Tramadol- if other treatments have been unsuccessful, while waiting for assessment by a specialist.
2) Morphine, and oxycodone- initiated only under specialist supervision.

Question 3

what treatment might be considered in patients with localised pain who are unable to take oral medicines?

Answer 3

1)Topical local anaesthetic preparations, e.g. lidocaine plasters, while awaiting specialist review
2) Capsaicin 0.075% cream for postherpetic neuralgia.
↳ Capsaicin 8% for peripheral neuropathic pain in non-diabetic patients under specialist

Question 4

what drug might be useful in compression neuropathy ?

Answer 4

A corticosteroid may help to relieve pressure

Question 5

Trigeminal neuralgia is also caused by dysfunction of neural tissue, but its management is distinct from other forms of neuropathic pain. Outline how this condition is managed

Answer 5

1) Surgery may be the treatment of choice
2) Carbamazepine taken during the acute stages reduces the frequency and severity of attacks (Blood counts and electrolytes should be monitored when high doses are given)

Question 6

which drugs are used in the management of chronic oral and facial pain?

Answer 6

Tricyclic antidepressants may be useful- Disorders of this type require specialist referral