Neuropathic pain encompasses a myriad of painful disease states that are often hard to treat, especially with one single medication. In the comprehensive treatment of neuropathic pain, the concept of complex polypharmacy is a rational approach, accompanied by physical and mental health therapies. Medications primarily used for neuropathic pain generally fall into the categories of anticonvulsants, antidepressants, opioids, and topical agents. Generally, most first-line medications used today show a response rate of approximately 30% to 50% reduction in pain in up to 50% of patients treated. There is no “gold standard” in regard to one medication for neuropathic pain. Some new medications have emerged during the past few years that help to augment the armamentarium of medications used in neuropathic pain. This paper reviews the definition of neuropathic pain and introduces the reader to the evidence-based literature on these new medications available for the treatment of neuropathic
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References and Recommended Reading
Backonja M: Defining neuropathic pain. Anesth Analg 2003, 97:785–790.
Beniczky S, Tajti J, Varga ET, et al.: Evidence-based pharmacological treatment of neuropathic pain syndromes. J Neural Transm 2005, 112:735–749.
Pullar S, Palmer AM: Pharmacotherapy for neuropathic pain: progress and prospects. Drug News Perspect 2003, 16:622–630.
Raja SN, Haythornwaite JA: Combination therapy for neuropathic pain—which drug, which combination, which patients? N Engl J Med 2005, 352:1373–1375.
Dworkin RH, Backonja M, Rowbotham MC, et al.: Advances in neuropathic pain: diagnosis, mechanism, and treatment recommendations. Arch Neurol 2003, 60:1524–1534.
Galluzzi KE: Management of neuropathic pain. J Am Osteopath Assoc 2005, 105(Suppl 4):S12–S19.
Barkin RL, Barkin SJ, Barkin DS: Perception, assessment, treatment, and management of pain in the elderly. Clin Geriatr Med 2005, 21:465–490, v.
Mendell JR, Sahenk Z: Painful sensory neuropathy. N Engl J Med 2003, 348:1243–1255.
Chong MS, Bajwa ZH: Diagnosis and treatment of neuropathic pain. J Pain Symptom Manage 2003, 25(Suppl 5):S4–S11.
Finnerup NB, Otto M, McQuay HJ, et al.: Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005, 188:289–305.
Farrar JT, Young JP Jr, LaMoreaux L, et al.: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001, 94:149–158.
Nicholson B, Verma S: Comorbities in chronic neuropathic pain. Pain Med 2004, 5(Suppl 1):S9–S27.
Berdine HJ: Neuropathic pain; current perspectives on diagnosis, treatment, and the pharmacist’s role in patient care. Pharmacy Times 2005, 71:97–106.
Belden H: First pain drug in new class comes from snail. Drug Topics 2005, 149:8.
Prialt prescribing information. https://www.prialt.com/downloads/product_information.pdf. Accessed January 16, 2006.
Wermeling DP: Ziconotide, an intrathecally administered N-type calcium channel antagonist for the treatment of chronic pain. Pharmacotherapy 2005, 25:1084–1094.
Staats PS, Yearwood T, Charapta SG, et al.: Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS. A randomized controlled trial. JAMA 2004, 291:63–70.
Collins R, Lieberburg I, Ludington E, et al.: Effectiveness of intrathecal ziconotide in multiple pain etiologies: a meta-analysis of three controlled trials [abstract]. Pain Med 2005, 6:195
Dissanayake S, Royal M, Wallace M: Incidence of adverse events in patients on long-term (at least 6 months) ziconotide [abstract]. J Pain 2003, 4(Suppl 1):73.
Fiekowsky S, Ludington E, Ellis D, et al.: Intrathecal ziconotide administration utilizing a slow titration schedule: assessment of the Brief Pain Inventory [abstract]. In American Society of Pain Management Nursing. Albuquerque, NM; March 31 to April 3, 2005.
Fisher R, Lieberburg I, Ludington E: Characterization of long-term intrathecal ziconotide use for patients with severe chronic pain following initial slow titration [abstract]. Pain Med 2005, 6:194.
Fisher R, Lieberburg I, Ludington E, et al.: Characterization of long-term intrathecal ziconotide use for patients with severe chronic pain following initial fast titration [abstract]. Pain Med 2005, 6:194.
Webster L: Efficacy of intrathecal ziconotide for the treatment of severe chronic pain in adults [abstract]. Pain Med 2005, 6:195–196.
Lyrica Product Monograph. New York: Pfizer, Inc; 2005.
Freeman R: The treatment of neuropathic pain. CNS Spectr 2005, 10:698–706.
Richter RW, Portenoy R, Sharma U, et al.: Relief of painful diabetic peripheral neuropathy with pregabalin: a randomized, placebo-controlled trial. J Pain 2005, 6:253–260.
Lesser H, Sharma U, LaMoreaux L, et al.: Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology 2004, 63:2104–2110.
EMEA: European Public Assessment Report (EPAR)—Lyrica. http://www.emea.eu.int/humandocs/humans/epar/lyrica/lyrica.ht. Accessed January 22, 2006.
Rosenstock J, Tuchman M, LaMoreaux L, et al.: Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Pain 2004, 110:628–638.
Sabatowski R, Gálvex R, Cherry DA, et al.: Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 2004, 109:26–35.
Van Seventer R, Bladin C, Hoggart B, et al.: Pregabalin dosed twice a day (BID) efficaciously and safely treats neuropathic pain associated with postherpetic neuralgia [poster 800]. Poster presented at the 23rd American Pain Society Annual Scientific Meeting. Vancouver, Canada; May 6–9, 2004.
Toelle T, Versavel M, Glessner C, et al.: A novel treatment for diabetic peripheral neuropathy: pregabalin dose and pain relief. Anesthesiology 2004, 101:A967.
Dworkin RH, Corbin AE, Young JP Jr, et al.: Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2003, 60:1274–1283.
Freynhagen R, Strojek K, Griesing T, et al.: Pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible and fixed-dose regimens. Pain 2005, 115:254–263.
Huppertz HJ, Feuerstein TJ, Schulze-Bonhage A: Myoclonus in epilepsy patients with anticonvulsive add-on therapy with pregabalin. Epilepsia 2001, 42:790.
Pregabalin (Lyrica) for neuropathic pain and epilepsy. A new drug similar to gabapentin (neurontin, and others). Med Lett Drugs Ther 2005, 47:75–76, 73.
Cymbalta prescribing information. http://pi.lilly.com/us/cymbalta-pi.pdf. Accessed January 12, 2006.
Westanmo AD, Gayken J, Haight R: Duloxetine: a balanced and selective norepinephrine-and serotonin-reuptake inhibitor. Am J Health Syst Pharm 2005, 62:2481–2490.
Goodman F: Duloxetine (Cymbalta) in Painful Diabetic Neuropathy and Fibromyalgia. Abbreviated National PBM Drug Monograph. VHA Pharmacy Benefits Management Strategic Health Care Group and the Medical Advisory Panel. (VA intranet) January 2005. http://vaww.pbm.va.gov/drugmonograph/6upaeduloxetine.pdf. Accessed January 10, 2006.
Goldstein DJ, Lu Y, Detke MJ, et al.: Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain 2005, 116:109–118.
Raskin J, Pritchett YL, Wang F: A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med 2005, 6:346–356.
Sativex product monograph. http://www.bayerhealth.com/display.cfm?Object_ID=272&Article_ID=122. Accessed January 5, 2006.
Press release from GW Pharma regarding announcement of FDA approval for US trial. http://www.gwpharm.com/news_press_releases.asp?id=/gwp/pressreleases/currentpress/2006-01-04. Accessed January 5, 2006.
Berman JS, Symonds C, Birch R: Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomized controlled trial. Pain 2004, 112:299–306.
Svendsen KB, Jensen TS, Bach FW: The cannabinoid dronabinol reduces central pain in multiple sclerosis. Randomised double-blind placebo controlled crossover trial. BMJ 2004, 329:253–261.
Okie S: Medical marijuana and the Supreme Court. N Engl J Med 2005, 353:648–651.
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Wallace, J.M. Update on pharmacotherapy guidelines for treatment of neuropathic pain. Curr Pain Headache Rep 11, 208–214 (2007). https://doi.org/10.1007/s11916-007-0192-6
- Neuropathic Pain
- Diabetic Peripheral Neuropathy
- Postherpetic Neuralgia