|
| |
| Treatment of Neuropathic pain |
| Painful polyneuropathy |
 | Metabloic
 | Most common is diabetes. DCCT trial: 69% reduction of neuropathy in
patients using intensive insulin therapy |
| Hypothyroidism |
| Uremia |
| Thiamine, Vit B compound deficiency |
| Alcohol |
|
| Drug toxicity
| Chemotherapeutic agents: Vincristine, Cisplatin, Tzxol |
| HIV med: dideoxyctidine(ddC) |
|
| Other causes
| HIV infection |
| Eosinophilia-myalgia syndrome |
| Hepatitis |
| Cancer |
| Systemic vasculitis, Connective tissue disorder: |
| Hereditary Sensory neuropathy type I |
| Amyloidosis
- Wash Univ |
|
|
| Principles of Treatment |
| Titrate 1 drug at a time |
| Initiate each drug with the lowest dose, slowly titrate up |
| Titrate the dose upward until
| significant pain relief (>50% pain relief) or |
| intolerable side effect |
|
| Continue medications if
| significant pain relief |
| tolerable side effects |
| increased activity & function |
|
|
| Antidepressants |
| Tricyclics
| Amitryptyline, Nortriptyline, Desipramine all been established as better
than placebo |
| For diabetic neuropathy: 30% of patients will have >50% pain relief |
| contrary to past teaching: help both the constant burning and lancinating
pain. |
| Start with the lowest available dose, watch for side effects |
|
| SSRI: mixed result, overall result is poor
| Controlled study of Fluoxetine on Diabetic neuropathy: no better than
placebo |
| Paroxetine: some benefit |
|
| Venlafaxine (Effexor)
| Reuptake inhibition of Serotonin & NE, minimal anticholinergic,
histaminergic effect |
|
|
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center
|
