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Sunday, December 10, 2023

What are First Line Agents to Help Nerve Pain when Diagnosed?

     Here is a good article summarizing the progression of medicines used to treat nerve pain in patients. We will focus on the first line therapies to help calm down the pain. Here is a summary from the abstract:

"Multidisciplinary conservative care and non-opioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as first-line therapy."

The TCAs most commonly prescribed today include: Anafranil (clomipramine), Asendin (amoxapine), Elavil (amitriptyline), Norpramin (desipramine), and Pamelor (nortriptyline).Two of the most common SNRIs are duloxetine and venlafaxine. Clinically used gabapentinoids include gabapentin, pregabalin, and mirogabalin, as well as a gabapentin prodrug, gabapentin enacarbil. Additionally, phenibut has been found to act as a gabapentinoid in addition to its action of functioning as a GABAB receptor agonist. There has recently been a warning not to use gabapentinoids in patients with respiratory problems. Common topicals are a myriad of compounding formulations with or without Ketamine. OTC topicals I use most are Neuro Eze and Neuro One both with L-Arginine in concentrated form. The transdermal product I use is 5% Lidoderm patches. 
Many patients try other nerve desensitizing treatments first, before drugs, with neural flossing or gliding, Acupuncture, TENS, and Quell units. 

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