Non-malignant pain part 2

Question 1

Good options for Fibromyalgia

Answer 1

Gabapentin (neurontin) - gabapentinoid
Pregabalin (lyrica) - gabapentinoid
Venlafazine (effexor) - SNRI
Duloxetine (cymbalta) - SNRI
Amitripyline (elavil) - TCA
Nortiprtyline (pamelor) - TCA

Question 2

Good options for neuropathy

Answer 2

Carbamazepine (tegretol)- antiepileptic
Gabapentin (neurontin) - gabapentinoid
Pregabalin (lyrica) - gabapentinoid
Venlafazine (effexor) - SNRI
Duloxetine (cymbalta) - SNRI
Amitripyline (elavil) - TCA
Nortiprtyline (pamelor) - TCA

Question 3

Good options for post operative pain

Answer 3

Gabapentanoids
Gabapentin - 100-300mg PO TID (MAX 3600mg/day)
pregabalin - 75mg PO BID (Max 600mg/day)

Question 4

Good options for Migraine prophylaxis

Answer 4

TCAs
Amitriptyline
Nortriptyline
10mg PO QHS (max 150mg/day)

Question 5

Good option for musculo- skeletal pain/ spasms

Answer 5

Muscle relaxants
Cyclobenzapine: 5mg PO TID max 30mg/day
Baclofen 5mg PO TID max 80mg day
Methocarbamol 1.5mg PO 3-4x day max 8mg day
Carisoprodol 250-350mg PO TID max 1050mg/day
Tizanidine 2-4mg PO q8-12h max 24mg/day

Question 6

Topical agents

Answer 6

Lidocaine - patch, injection, topical agent

Capsacin: used for muscle/joint pain, neuropathic pain

Question 7

Considerations in those 65 or older

Answer 7

AVOID
- Muscle relaxers
- opioids and benzos
- opioids and gabapentin
- anticholinergic agents

CAN USE WITH CAUTION
- SNRI, TCA, Carbamazepine
- NSAIDS
- Topical agents