Ver el código de «Neuropathic pain»

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

==Management==
*Do not consider starting patients on medications unless they will definitely obtain good follow-up
*First line medication options (all have NNT from ~2-3 or better)
**[[Antiepileptics]] - gabapentin, topiramate
**[[TCAs]] - [[amitriptyline]], [[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 patient in ED):
**Injections - trigger point, epidural steroid injections, facet injections, medial branch blocks, joint steroid injections
**Radiofrequency ablations
**Spinal implants
**Determination of long-term opioids
**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:Neurology]]