Breadcrumb trail
- Centre for Pain Medicine
- Pain Medicine
- Neurology
- Therapy of Neuropathic Pain
Contents
Therapy of Neuropathic Pain
According to current international guidelines for the treatment of neuropathic pain, several types of drug are considered first-line therapies for peripherally generated neuropathic pain: Tricyclic antidepressants (e.g., amitriptyline); calcium antagonists (e.g., gabapentin, pregabalin); and selective serotonin and noradrenaline reuptake inhibitors (SSNRI, e.g., duloxetine, venlafaxin).
Opoids such as morphine are considered second-line drugs for neuropathic pain. Their efficacy does not differ from that of the first-line drugs mentioned above; however, as they tend to be associated with more side effects than the antidepressants and calcium antagonists as well as the risk of development of opioid hyperalgesia and opioid dependence, they are classified as second-line medications.
If successful therapy cannot be achieved with the above medications, third-line drugs may also be employed. These include substances for which only one study with positive results exists or the available data are inconsistent. This group includes the sodium-channel antagonists (e.g., carbamazepine, oxcarbazepine, lamotrigine); the selective serotonin reuptake inhibitors (SSRI); NMDA antagonists; lidocaine analogs; or capsaicin.
The therapeutic options for centrally generated neuropathic pain are more limited. Tricyclic antidepressants are the first-line therapy for post-stroke pain, and calcium antagonists for pain due to spinal-cord lesions. If these drugs are not effective or are contraindicated, the first- and second-line drugs for peripherally generated neuropathic pain listed above can be tried.
