Pharmacological management of neuropathic pain

Abstract

While pain management is best assessed and treated using a biopsychosocial model, this review focuses on recent updates in the prescription of medications for neuropathic aspects of severe pain, including opioid management.

Current treatment options for post-thoracotomy pain syndrome: a review

“…They should be used with great caution due to cardiotoxic side effects especially in patients with ischemic heart disease and ventricular dysfunction. Tricyclic antidepressants are among the first-line treatments in neuropathic pain treatment guidelines [36][37][38][39].…”

“…Anticonvulsants: These drugs bind to the alpha 2-delta subunit of voltage-dependent calcium chan-nels, and reduce the release of neurotransmitters such as glutamate, noradrenaline, and substance P. The effects, side effects and patient tolerance profiles of pregabalin and gabapentin have similar properties. Dizziness, somnolence, peripheral edema, and dry mouth may develop after the use of this group of drugs [36,40]. Because pregabalin has linear pharmacokinetics, dose adjustment is easier, analgesic effects occur faster than gabapentin, and there are also positive effects on common anxiety disorder and sleeping [37,41,42].…”

“…Apart from this, there are also gastrointestinal side effects, such as dry mouth and constipation. Tolerance to these side effects can be improved by appropriate dose titration in patients with nausea [36]. Venlafaxine should be used with caution in patients with cardiac problems as it may cause hypertension and impaired cardiac conduction.…”

“…Topical lidocaine: 5% lidocaine patch was found to be effective in localized peripheral neuropathic pain cases where allodynia was predominant [36].…”

“…It is among the second-line treatments in neuropathic pain treatment guidelines. However, it can be used as a first-line treatment in acute exacerbations of pain [36,39,47,48].…”