Neuratic Pain Treatment

Non invasive

Analgesics Intravenous lidocain infusions (pain relief for 2-3 weeks) Continous spinal inpusion of opioid or clonidine via an implantable pump

Invasive

Neuratic Pain Guideline (Non invasive)

First Line

Second Line

Third Line
Fourth Line Cannabinoids, Methadone, SSRIs, other anti convulsants

First line
Antidepresants Tricyclic antidepressants the starting dose is low (for example amitriptyline 1012.5 mg at bedtime) and is increased slowly at intervals of a few days to a week. The maximum effective dose is disputed, but usually 75 mg at night is sufficient. TheAnticonvulsans

gabapentin and pregabalin have been more extensively studied in patients with diabetic neuropathy and postherpetic neuralgia. These two drugs modify the action of voltage-gated calcium channels of primary afferents so appear to interfere with the release of substance P, noradrenaline and the excitatory amino acid neurotransmitter glutamate.

Second line

Serotonin noradrenaline reuptake inhibitor

Venlafaxine has shown efficacy in trials involving painful diabetic neuropathy and mixed painful ply neuropathy at dose of 150 mg to 225 mg per day Lidocaine patch 5% has been shown to be useful in the management of a variety of focal Neuropatic pain syndrome

Topical lidocaine

Third line

Opioid analgesics

Tramadol a weak opioid agonist and mimics some of the properties of the TCAs Morphine showed a significant reduction in pain intensity, with variable improvement in sleep and disabilty

Fourth line

Cannabinoids produced modest analgesia in central pain in multiple sclerosis Methadone a synthetic opioid analgesic that useful in the management of neuropatic pain because it has N-methyl-D-aspartate antagonist properties