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Tuesday, March 2, 2021

Review of Oral Medications Used in Peripheral Nerve Pain;year=2019;volume=67;issue=7;spage=32;epage=37;aulast=Lovaglio

  • Lyrica (pregabalin) and Neurotin (gabapentin) are Calcium Channel Ligands and the fixtures of first line treatment
  • Tricyclic anti-depressants, especially amitriptyline and nortripyline, are normally mixed right after maximum dose is achieved with the first line.
  • Other anti-convulsants (carbamazepine and clonazepam or lamotrigine) may also be added, along with other neuroleptic drugs
  • The goal is to drive this pain down (8-10 VAS to 0-2 VAS) and then maintain the dosage for several months before beginning the wean process
  • Based on the Pharmacological principle of Potentiation Synergy 2 or 3 drugs are so much better than one 
  • Therefore, Tricyclic + Lyrica or Neurontin = First Line then add Anti-convulsants 
  • 2nd line anti-depressants are venlafaxin and duloxetine
  • Gaba usually 300 mg daily for 3-4 days then gradually built to 1200 mg 3 times a day
  • Or, Lyrica (which works both peripheral and central) start with 50-75 mg day and gradually increase to 600 mg which is spread over 2 or 3 doses
  • Anti-depressants (also called serotonin-noradrenaline reuptake inhibitors) are started at 10-25 mg at bedtimes and slowly increased to an effective dose of 50-150 mg/day
  • Topicals (lotion or patches) tend to have lidocaine
  • However Capsaicin topical also works on some (from peppers)
  • Other non-pharm options are: alcohol or marijuana, psychotherapy, hypnosis, occupational therapy, PT, acupuncture, and TENS 

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