TAILIEUCHUNG - Chapter 012. Pain: Pathophysiology and Management (Part 9)

Treatment of Neuropathic Pain It is important to individualize treatment for patients with neuropathic pain. Several general principles should guide therapy: the first is to move quickly to provide relief; a second is to minimize drug side effects. For example, in patients with postherpetic neuralgia and significant cutaneous hypersensitivity, topical lidocaine (Lidoderm patches) can provide immediate relief without side effects. Anticonvulsants (gabapentin or pregabalin, see above) or antidepressants can be used as first-line drugs for patients with neuropathic pain. Antiarrhythmic drugs such as lidocaine and mexiletene can be effective (see above). There is no consensus on which class of. | Chapter 012. Pain Pathophysiology and Management Part 9 Treatment of Neuropathic Pain It is important to individualize treatment for patients with neuropathic pain. Several general principles should guide therapy the first is to move quickly to provide relief a second is to minimize drug side effects. For example in patients with postherpetic neuralgia and significant cutaneous hypersensitivity topical lidocaine Lidoderm patches can provide immediate relief without side effects. Anticonvulsants gabapentin or pregabalin see above or antidepressants can be used as first-line drugs for patients with neuropathic pain. Antiarrhythmic drugs such as lidocaine and mexiletene can be effective see above . There is no consensus on which class of drug should be used as a first-line treatment for any chronically painful condition. However because relatively high doses of anticonvulsants are required for pain relief sedation is very common. Sedation is also a problem with the tricyclic antidepressants but is much less of a problem with serotonin norepinephrine reuptake inhibitors SNRIs . venlafaxine and duloxetine . Thus in the elderly or in those patients whose daily activities require high-level mental activity these drugs should be considered as the first line. In contrast opioid medications should be used as a second- or third-line drug class. While highly effective for many painful conditions opioids are sedating and their effect tends to lessen over time leading to dose escalation and occasionally a worsening of pain due to physical dependence. Drugs of different classes can be used in combination to optimize pain is worth emphasizing that many patients especially those with chronic pain seek medical attention primarily because they are suffering and because only physicians can provide the medications required for pain relief. A primary responsibility of all physicians is to minimize the physical and emotional discomfort of their patients. Familiarity with .

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