[Pharmacotherapy for neuropathic pain caused by injury to the afferent nerve fibers].
Phantom pain, a form of neuropathic pain, is caused by damage to somatosensible afferent nerve fibres in the peripheral or central nervous system. Often, the pain cannot be satisfactorily treated with nonsteroidal anti-inflammatory drugs. Dependent on the underlying mechanism the pain is treated with either antidepressants (for more or less continuous pain) or anti-epileptics (for paroxysmal pain). Of the antidepressants, the tricyclic antidepressants are the best studied and most prescribed. The activity of new drugs, such as the selective serotonin reuptake inhibitor paroxetine as well as venlafaxine, has yet to be clearly shown. Of the anti-epileptics, carbamazepine and phenytoin are the most prescribed. New drugs which provide greater pain relief than the placebo are oxcarbazepine, gabapentine and lamotrigine. Other effective drugs for phantom pain are: gamma-butyric acid agonists (baclofen), opiates (morphine preparations with a regulated release; phentanyl patch), the N-methyl-D-aspartate receptor antagonist amantadine, transdermally administered clonidine and locally applied lidocaine.
Weber
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Academisch Ziekenhuis, afd. Neurologie, Postbus 5800, 6202 AZ Maastricht.
D000547:Amantadine / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy; D006801:Humans; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D009475:Neurons, Afferent / Q000473:pathology*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D011115:Polyneuropathies / Q000188:drug therapy
D018712:Analgesics, Non-Narcotic; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D009125:Muscle Relaxants, Central; D009294:Narcotics; D000547:Amantadine; D001418:Baclofen