Pain- Treatment Guidelines and Tips

Question 1

Generally speaking, what agents are used first line?

Answer 1

TCAs, SNRIs, gabapentin, pregabalin

Question 2

When can you use topical lidocaine and/or capsaicin?

Answer 2

If there’s a distinct location

Question 3

Generally speaking, pain treatment is directed at what?

Answer 3

Reducing/stabilizing nervous system activity

Question 4

True or false: drugs effective in 1 or more neuropathic syndromes are reasonable choices for other neuropathies

Answer 4

True

Question 5

Onset of action for pain meds

Answer 5

Days-weeks, counsel patients and let them know that these meds won’t act like a PRN med for a headache

Question 6

Meds you can try in PDN (generally)

Answer 6

TCAs, SNRIs, gabapentin, pregabalin

Question 7

Meds you can try in PHN (generally)

Answer 7

TCAs, gabapentin, pregabalin, tramadol, lidocaine, capsaicin

Question 8

For PDN, if you start a patient on pregabalin, gabapentin, TCA, or an SNRI and it doesn’t work, what’s your next step?

Answer 8

Try a med from a different drug class (ex: if you start them on a TCA, try an alpha-2-delta-agonist or an SNRI like duloxetine) or tramadol

Question 9

If the PDN isn’t controlled even after switching meds around, what do you do?

Answer 9

Try combo therapy

Question 10

What is not recommended for chronic pain?

Answer 10

Opioids