The pharmacological management of neuropathic pain

Youngkwon Ko; Yoon Hee Kim

doi:10.5124/jkma.2012.55.6.582

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Ko and Kim: The pharmacological management of neuropathic pain

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2012; 55(6): 582-592.

Published online: 14 June 2012

DOI: https://doi.org/10.5124/jkma.2012.55.6.582

The pharmacological management of neuropathic pain

Youngkwon Ko, MD, Yoon Hee Kim, MD

Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon, Korea.

Corresponding author: Yoon Hee Kim, yhkim0404@cnu.ac.kr

Received 12 April 2012 Accepted 26 April 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Neuropathic pain has recently been defined as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system". Neuropathic pain is a debilitating chronic condition that remains very difficult to treat and challenging to manage. Tricyclic antidepressants (amitryptiline, nortriptyline, imipramine), selective serotonin and norepinephrine reuptake inhibitors (duloxetine, venlafaxine), anticonvulsants (gabapentin, pregabalin), and 5% lidocaine patches have demonstrated efficacy in neuropathic pain and are recommended as first-line medications. In patients who fail to respond to these first-line medications alone and/or in combination, opioid analgesics or tramadol can be used as a second-line treatment alone or in combination with one of the first-line medications. Opioid analgesics and tramadol can also be considered for first-line use in selected clinical circumstances. Other pharmacological therapeutic options include selective serotonin reuptake inhibitors, antiepileptic drugs (levetiracetam, lacosamide, lamotrigine, valproic acid), cannabinoids, high concentration capsaicin patch, and botulinum toxin A. Medication selection should be individualized, with side effects taken into consideration as well as potential beneficial or deleterious effects on comorbidities, and whether or not prompt onset of pain relief is necessary.

Keywords: Neuropathic pain, Pharmacologic management, Evidence-based recommendations

Figures and Tables

Table 1

Classifications of neuropathic pain

Table 2

First-line medications to treat neuropathic pain

GI, gastrointestinal; HR, heart rate; BP, blood pressure; ECG, electrocardiogram; SSRI, selective serotonin reuptake inhibitor; SSNRI, selective serotonin and norepinephrine reuptake inhibitor; TCA, tricyclic antidepressant.

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