Chronic neuropathic pain may be more challenging to treat than other forms of chronic pain. However, several nonopioid medications have demonstrated efficacy in patients with neuropathic pain. This chapter will summarize the evolving evidence base supporting nonopioid pharmacotherapy for neuropathic pain. Three classes of medications are consistently considered first-line treatments for neuropathic pain: certain antidepressants, including tricyclics, duloxetine, and venlafaxine; calcium channel α2δ ligands (ie, gabapentin and pregabalin); and topical lidocaine for localized, peripheral neuropathic pain. Several additional medications have been studied in neuropathic pain but have produced less favorable results. This chapter also will summarize a recommended approach to the management of patients with chronic neuropathic pain. Continuum Lifelong Learning Neurol 2009;15(5):70-83.
Relationship Disclosure: Dr O'Connor has received research support from Endo Pharmaceuticals, the Mayday Fund, and the US NIH. Dr Dworkin has received personal compensation for activities from Allergan, Inc., Alpharma, Arcion Therapeutics, Inc., Astellas Pharma Inc., AstraZeneca, BioLineRx, Cara Therapeutics, Cervelo Pharmaceuticals Inc., Eisai Inc., Eli Lilly and Company, Endo Pharmaceuticals, Forest Pharmaceuticals, Inc., Genzyme Corporation, Grünenthal, Johnson & Johnson Services, Inc., KAI Pharmaceuticals, King Pharmaceuticals Co., Ltd., Merck & Co., Inc., NeurogesX, Neuromed, Nuvo Research Inc., Ono Pharmaceuticals Inc., Pfizer Inc, Phillips Respironics, Solace Pharmaceuticals, UCB Inc., and XTL Biopharmaceuticals. Dr Dworkin has received research support from Arcion Therapeutics, NeurogesX and the US NIH. Dr Dworkin is a special government employee of the US Food and Drug Administration Center for Drug Evaluation and Research.
Unlabeled Use of Products/Investigational Use Disclosure: Drs O'Connor and Dworkin discuss the unlabeled use of medications that have shown efficacy in at least one type of neuropathic pain in one or more high-quality randomized controlled trials. No drugs have been approved by the US Food and Drug Administration for the treatment of neuropathic pain.