Pharmacotherapy for neuropathic pain.
Refractory neuropathic pain can be devastating to a patient's quality of life. Ideally, the primary goal of therapy would be to prevent the pain, yet even the most appropriate treatment strategy may be only able to reduce the pain to a more tolerable level. Pharmacotherapy is currently the mainstay of treatment in patients with neuropathic pain, although at present the drugs are used on a mainly "off-label" basis. A wide variety of agents are used, especially antidepressants (ie, tricyclic antidepressants, selective serotonin-reuptake inhibitors) and anticonvulsants, but also opioids and tramadol, topical agents (eg, lidocaine), systemic local anesthetics, and anti-inflammatories. Even so, effective pain relief is achieved in less than half of patients with chronic neuropathic pain. In refractory patients, combination therapy using two agents with synergistic mechanisms of action may offer greater pain relief without compromising the side-effect profile of each agent.
Jackson
Kenneth C
KC
Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah 84108, USA. kenneth.jackson@hsc.utah.edu
D000700:Analgesics / Q000145:classification / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy* / Q000503:physiopathology; D009480:Neuropharmacology / Q000379:methods / Q000639:trends*; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000503:physiopathology
D000700:Analgesics; D000927:Anticonvulsants; D000928:Antidepressive Agents