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Guidelines for the pharmacological treatment of neuropathic pain.

I recently came across a 'Mayo Clinic Proceeding' that may be of interest to those who experience Neuropathic Pain.... and that's a lot of us.

Apparently, the Neuropathic Pain Special Interest Group of the 'International Association for the Study of Pain' sponsored the development of some 'evidence-based' guidelines.

You may read it by googling:[/u]
Mayo Clin Proc. 2010 March; 85(3_suppl): S3-S14

First-line treatment options:
  • Tricyclic antidepressants,
  • dual reuptake inhibitors of serotonin and norepinephrine,
  • calcium channel α2-δ ligands (ie, gabapentin and pregabalin), and
  • topical lidocaine.
Second-line treatment options:
  • Opioid analgesics, and
  • tramadol.
So it appears that there are more medicinal tools available for doctors to use. Some of these first line treatments are not often mentioned by members as being prescribed to them.

Something to think about! Possibly an opportunity for improved pain management by discussing this tactfully with our doctors?

(For completeness, I've included these definitions.
Neuropathic Pain has recently been redefined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.”
"The somatosensory system is a diverse sensory system comprising the receptors and processing centres to produce the sensory modalities such as touch, temperature, proprioception (body position), and nociception (pain)." "Sensory receptors cover the skin and epithelia, skeletal muscles, bones and joints, internal organs, and the cardiovascular system.")


  • backpain67bbackpain67 Posts: 95
    edited 12/21/2012 - 3:32 AM
    I had no luck with the 1st line and need to take Norco 10mg 5 x day but starting next month I will be taking only 4 x day
    they also prescribed restoril at night to help with staying asleep but it doesn't work very well.
    C3-4-5 fusion 2005
    C-5-T-1 disk bulged
    L-4-5 bulge to the right, with Microdiscectomy, failed
    L5- Bi-Lateral bulge
    Pain in right foot -loss of feeling
    Left butt, hip and front thigh pain with bad shooting pain into inside ankle sometimes
  • RickilalasRRickilalas Posts: 559
    edited 12/27/2012 - 12:09 PM
    After my first surgery they put me on elavil for nerve pain. I thought it was just another pain Med. Turns out its a
    Antidepressant that works on spinal pain. One word of caution, I was on 50mg once a day and it did help. I did developed some very major tremors in arms and legs and had to stop it after about four years. The issues went away in about a week. The pain went up and I asked to go back on it as it helps so much. They decided I could try a small 10mg tablet as long as the tremors did not return. So far so good.

    I am surprised more people are not using this as it helps and is very cheap, less then $5 a month. I have talked about this with a few of my spine PT friends and the ones that asked their doctors about it are pretty happy with it. It does not replace a narcotic but its another tool to help.
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