New and emerging treatment options for neuropathic pain

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Am J Manag Care. 2006 Jun;12(9 Suppl):S269-78.

New and emerging treatment options for neuropathic pain.

Gidal BE.

Barry E. Gidal, PharmD, RPh; Department of Neurology; University of

Wisconsin; 777 Highland Ave; Madison, WI 53705.

A large number of neuroanatomical, neurophysiologic, and

neurochemical mechanisms are thought to contribute to the development

and maintenance of neuropathic pain (NP). As a result, a

corresponding wide range of treatments have been employed to treat

patients with NP, including antiepileptic drugs, opioid analgesics,

tricyclic antidepressants, selective serotonin reuptake inhibitors,

serotonin-norepinephrine reuptake inhibitors, N-methyl-D-aspartate

receptor antagonists, cholecystokinin receptor antagonists,

adenosine, lipoic acid, cannabinoids, isosorbide dinitrate,

dronabinol, capsaicin, protein kinase C inhibitors, aldose reductase

inhibitors, and VR-1 receptor modulators.

Many of these compounds are limited by marginal efficacy and

clinically significant adverse events; few have been evaluated in

well-controlled, large-scale clinical trials. At present, the only

agents approved for the treatment of painful diabetic peripheral

neuropathy and postherpetic neuralgia are lidocaine patches 5%,

duloxetine, gabapentin, and pregabalin. Of these, only pregabalin is

indicated for both conditions.