Pain / Neuropathic pain

Question 1

What can cause neuropathic pain?

Answer 1

• phantom limb pain
• compression neuropathies
• peripheral neuropathies (eg diabetic, chronic alcohol, HIV, chemo, idiopathic)
• trauma
• central pain (eg after stroke, spinal cord injury, syringomyelia)
• postherpetic neuralgia
• deficit area with allodynia (pain on non-noxious stimuli)
• trigeminal neuralgia (different management)

Question 2

Drugs used for neuropathic pain?

Answer 2

Follow ladder:

• paracetamol
• gabapentin
• pregabalin
• amitriptyline (used less as anticholinergic side effects)
• duloxetine

Question 3

What is prescribed for pain regular and PRN?
pain ladder:
free
mild
severe

Answer 3

no pain - nil + PRN paracetamol 1g 6 hourly max 4g

mild pain - paracetamol 1g 6 hourly + PRN codeine 30mg 6 hourly

severe pain - co-codamol 30/500mg 2tabs 6hourly + PRN morphine titrate up to 10mg 6 hourly