updated neuropathic pain guidelines

[Guest guest]

Arch Neurol 2003 ;1524-1534,1537-1540

NEW YORK Reuters Health

Opioids, tricyclic antidepressants, gabapentin (neurontin), topical

lidocaine and tramadol (ultram) are appropriate for initial treatment of

neuropathic pain, an international panel of investigators reports in the

Archives of Neurology for November.

And when medication fails to relieve symptoms, neurosurgical

interventions are

increasingly successful, Dr. Cole A. Giller maintains in a second report

in the

Archives.

Dr. H. Dworkin, at the University of Rochester School of Medicine

and

Dentistry, New York, and participants in the Fourth International

Conference on the Mechanisms and Treatment of Neuropathic Pain reviewed

published information to develop treatment recommendations for patients

with neuropathic pain.

" Patients in pain have to be recognized and treated as assertively and

as appropriately as soon as possible " to increase the likelihood that

treatment will be successful, co-author Dr. R. Argoff told

Reuters Health. When deciding on treatment, physicians should consider a

medication's efficacy, cost, side effects, ease of use, and drug-drug

interactions.

Up to 50% of primary care providers consider nonsteroidal

anti-inflammatory drugs (NSAIDs) an appropriate first line treatment for

neuropathic pain. But " NSAIDs are not effective for this type of pain,

and they pose a significant risk for side effects, " said Dr. Argoff, a

faculty member at New York University Medical School. However, patients

with comorbid nonneuropathic pain may benefit if an NSAID is added to

the treatment regimen, he said.

One option is an opioid drug. " Old teachings that neuropathic pain is

resistant to opiates is nonsense, " Dr. Argoff said. When an opiate is

used as treatment for medical conditions, " it is extraordinarily

unlikely that the patient will become a drug addict. "

The 5% lidocaine patch (Lidoderm, Endo Pharmaceuticals) is FDA approved

for treatment of postherpetic neuralgia. " A large multicenter trial has

also showed that it could be used for low back pain, " Dr. Argoff added,

and he has found it useful for the treatment of other localized pain

conditions.

If physicians are not comfortable with treating neuropathic pain, Dr.

Argoff advises referral to " a neurologist, an anesthesiologist, or a

podiatrist, anyone with skill in pain assessment, diagnosis and

treatment. "

In his article, Dr. Giller outlines the major neurosurgical

interventions for neuropathic pain. Electrical stimulation of the spinal

cord, motor cortex, and deep brain often precedes ablative procedures.

Nowadays, radiofrequency is most commonly used for ablative techniques,

he notes, because of its ability to precisely control lesions size.

Another option is long-term intraspinal drug delivery, useful for cancer

pain as well as other benign pain types.

[Guest guest]

Gretchen, I do appreciate receiving these updates. Seeing the topical

lidocaine mentioned in this article prompted me to comment.

I have been having significant problems with neuropathic pain, particularly

in my left foot, although both are affected. This does not occur on a daily

basis, it just occurs without any specific reason that I can pinpoint. I

have not been able to tolerate Neurontin or Lexapro. I was given a

prescription for Lidocaine ointment a couple of weeks ago and it has helped

tremendously. It takes very little of the ointment to apply on my foot/toes

and I have found that the relief comes very quickly and I stay relieved. I

do not have to worry about the central nervous system side effects of

dizziness, forgetfulness, etc. like the Neurontin and Lexapro can cause. I

know they do not cause that for everyone, but for me they did.

The Lidocaine also comes in a patch form as well which may be helpful for

other body parts when the ointment would not be appropriate or could stain

clothing.

Blair

----- Original Message -----

From: " Gretchen Glick " <liliwigg@...>

" ers at groups " < >

Sent: Friday, November 21, 2003 10:55 AM

Subject: updated neuropathic pain guidelines

> Arch Neurol 2003 ;1524-1534,1537-1540

>

> NEW YORK Reuters Health

>

> Opioids, tricyclic antidepressants, gabapentin (neurontin), topical

> lidocaine and tramadol (ultram) are appropriate for initial treatment of

> neuropathic pain, an international panel of investigators reports in the

> Archives of Neurology for November.

>

> And when medication fails to relieve symptoms, neurosurgical

> interventions are

> increasingly successful, Dr. Cole A. Giller maintains in a second report

> in the

> Archives.

>

> Dr. H. Dworkin, at the University of Rochester School of Medicine

> and

> Dentistry, New York, and participants in the Fourth International

> Conference on the Mechanisms and Treatment of Neuropathic Pain reviewed

> published information to develop treatment recommendations for patients

> with neuropathic pain.

>

> " Patients in pain have to be recognized and treated as assertively and

> as appropriately as soon as possible " to increase the likelihood that

> treatment will be successful, co-author Dr. R. Argoff told

> Reuters Health. When deciding on treatment, physicians should consider a

> medication's efficacy, cost, side effects, ease of use, and drug-drug

> interactions.

>

> Up to 50% of primary care providers consider nonsteroidal

> anti-inflammatory drugs (NSAIDs) an appropriate first line treatment for

> neuropathic pain. But " NSAIDs are not effective for this type of pain,

> and they pose a significant risk for side effects, " said Dr. Argoff, a

> faculty member at New York University Medical School. However, patients

> with comorbid nonneuropathic pain may benefit if an NSAID is added to

> the treatment regimen, he said.

>

> One option is an opioid drug. " Old teachings that neuropathic pain is

> resistant to opiates is nonsense, " Dr. Argoff said. When an opiate is

> used as treatment for medical conditions, " it is extraordinarily

> unlikely that the patient will become a drug addict. "

>

> The 5% lidocaine patch (Lidoderm, Endo Pharmaceuticals) is FDA approved

> for treatment of postherpetic neuralgia. " A large multicenter trial has

> also showed that it could be used for low back pain, " Dr. Argoff added,

> and he has found it useful for the treatment of other localized pain

> conditions.

>

> If physicians are not comfortable with treating neuropathic pain, Dr.

> Argoff advises referral to " a neurologist, an anesthesiologist, or a

> podiatrist, anyone with skill in pain assessment, diagnosis and

> treatment. "

>

> In his article, Dr. Giller outlines the major neurosurgical

> interventions for neuropathic pain. Electrical stimulation of the spinal

> cord, motor cortex, and deep brain often precedes ablative procedures.

>

> Nowadays, radiofrequency is most commonly used for ablative techniques,

> he notes, because of its ability to precisely control lesions size.

> Another option is long-term intraspinal drug delivery, useful for cancer

> pain as well as other benign pain types.

>

>

>

> For more information, we recommend the

> CMT Today Magazine - $40 per year (6 issues)

>

> CONTACT:

> CMT Today

> R.R. #1 Hillsburg ON

> NOB 1Z0 Canada

>

>

>

>