Ver el código de «Neuropathic pain»

==Background==
*Neuropathic pain responds best to multifaceted approach - not to opiates
*If opiates can be avoided, it helps PCPs and pain management specialists create a better regimen
*Cornerstone of pain management is activity (exercise, PT, aquatherapy), but opiates/benzodiazepines restrict this

==Management==
*Do not consider starting pts on medications unless they will definitely obtain good followup
*First line medication options (all have NNT from ~2-3 or better)
**AEDs - gabapentin, topiramate
**TCAs - amitryptyline, nortriptyline
**Duloxetine (especially if TCAs contraindicated)
**Pregabalin
**NSAIDs and tylenol
*Second line medications (temporary relief, not long term)
**Tramadol
**Muscle relaxants - cyclobenzaprine, methocarbamol, diazepam
*Refer to pain specialist for multidisciplinary approach
*Pain specialists can offer (discussion with pt in ED):
**Injections - trigger point, epidural steroid injections, facet injections, medial branch blocks, joint steroid injections
**Radiofrequency ablations
**Spinal implants
**Determination of long-term opiates
**Pain psychology
**Spinal manipulation
*Lifestyle changes
**Weight loss
**Sobriety, reduction of polypharmacy, smoking cessation
**Exercise, avoidance of bed rest, core strengthening

==References==
Rathmell JP. A 50-year-old man with chronic low back pain. JAMA. 2008;299(17):2066-77.

[[Category:Neuro]]