Medical Blog

Treatment

Neuropathic pain is difficult to treat. In most patients, a multidisciplinary pain treatment in a designated center.
Often the doctor will turn various means test to determine what may or may not work without too severe side effects.
Non-drug treatments such as neurosurgery, spinal cord and brain stimulation, transcutaneous electrical nerve stimulation (TENS) and psychological therapy are used with varying effect. The efficacy of this is not established in controlled trials.
In some forms of pain may be useful to any tight clothing. In pain after mastectomy gives one time to rest and the affected arm elevation in many cases reduce the pain. Failure to move the arm (eg during long train journey) can also cause back pain. So look for a balance between exercise and rest and try to do relaxation and distraction.

Painkillers

Neuropathic pain usually responds not to the usual analgesics and nonsteroidal anti-inflammatory drugs. Some hybrids can have an impact, but it has not directly with the neuropathic pain component of that network. The classic WHO analgesic ladder with which many doctors are familiar with, has little use for neuropathic pain.
Studies do show a positive (but inter-individually varying) effect of narcotic analgesics (such as fentanyl and tramadol) in cancerous and non-cancerous neuropathic pain. It is not expected immediately, we must therefore continue to take some time to assess the effective and to determine the correct dose. Usually they are experiencing a partial effect.

Antiepileptic drugs

The usefulness of some anti-epileptic drugs in the treatment of certain neuropathic pain, is well documented. Carbamazepine (Tegretol) and phenytoin are effective in diabetic neuropathy. Carbamazepine has also demonstrated efficacy in trigeminal neuralgia. The newer AEDs are gabapentin (Neurontin) and pregabalin (Lyrica) a positive effect in postherpetic neuralgia and diabetic neuropathy demonstrated. The newer anticonvulsants gabapentin and pregabalin in particular have the great advantage that they give quick results, are well tolerated and few side effects. Moreover, pregabalin improves sleep patterns very quickly. The pain is still not under control, but after a few days people feel better because they sleep better and better equipped.

Antidepressants

The (older) tricyclic antidepressants such as amitriptyline, carbamazepine and nortriptyline in low doses among the first choice medication for neuropathic pain, diabetic neuropathy and herpetic neuralgia, even though the leaflet is not always that indication and are not always or only under certain conditions, reimbursement for that indication. Patients should during the first months very well be followed to determine the optimal dosage.

Local treatment

For certain neuropathic pain (for diabetic neuropathy and post-herpetic neuralgia), local healing center to be used, eg chilli cream (capsaicin) or lidocaine cream.