Summary:
- 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
