http://www.fpnotebook.com/
Chronic Pain Management
- See Also
- Management: General
- Treat specific rheumatic conditions
- Treat Myofascial Pain
- Consider physical rehabilitation methods
- Approach is similar to treatment of Somatization
- Non-Pharmacologic Management is critical
- See Somatization Management
- See Somatoform Disorder Management Pitfalls
- Management
- Medications augment non-pharmacologic management
- Analgesics
- Tricyclic Antidepressants
- Nighttime only use (Tertiary amines)
- Amitriptyline (Elavil)
- Imipramine (Tofranil)
- Doxepin (Sinequan)
- Daytime and nighttime use (Secondary amines)
- Nighttime only use (Tertiary amines)
- Novel Antidepressants with efficacy in Chronic Pain
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Bupropion (Wellbutrin)
- Anticonvulsants
- Indicated for sharp, lancinating, intermittent pain
- Potential Agents
- Gabapentin (Neurontin)
- Most studied anticonvulsant for neuropathic pain
- Titrate to effective doses (2400 to 3600 mg/day)
- Indications
- Carbamazepine (Tegretol)
- Primary indication: Trigeminal Neuralgia
- Other indications with modest efficacy
- Pregablin (Lyrica)
- New agent pending FDA approval in 2005
- Indications
- Phenytoin (Dilantin)
- Valproic Acid (Depakote)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
- Gabapentin (Neurontin)
- Adjunctive agents
- Avoid Narcotics if possible
- Avoid Benzodiazepines
- Experimental protocols: Cannabinoids
- CT-3 appears to reduce neuropathic pain
- Karst (2003) JAMA 290:1757
- References
- Ansari (2000) Harv Rev Psychiatry 7:257
- Barkin (2000) Am J Ther 7:31
- Bajwa (1999) Neurology 52:1917
- Dellemijn (1999) Pain 80:453
- Kingery (1997) Pain 73:123
- Laird (2000) Ann Pharmacother 34:802
- Maizels (2005) Am Fam Physician 71(3):483
- McQuay (1995) BMJ 311:1047
- Sindrup (1999) Pain 83:389
- (2000) Med Lett Drugs Ther 42(1085):73