From the Guidelines
Oral medication options for post-stroke neuropathic pain include anticonvulsants, tricyclic antidepressants, and SNRIs.
First-line treatment options
- Amitriptyline is a reasonable first-line pharmacological treatment 1
- Gabapentin or pregabalin can be used as first-line treatment for central post-stroke pain (CPSP) 1
- Lamotrigine is also a reasonable first-line pharmacological treatment 1
Second-line treatment options
- Duloxetine, an SNRI, can be used as second-line treatment 1
- Pregabalin, gabapentin, carbamazepine, or phenytoin may be considered as second-line treatments 1
Additional considerations
- Opioids or tramadol can be used for patients resistant to first and second-line treatment, but with caution due to the risk of physical dependency 1
- Treatment should be individualized to the patient’s needs and response to therapy, and any side effects 1
From the Research
Oral Medication Options for Post-Stroke Neuropathic Pain
The following oral medications have been studied for the treatment of post-stroke neuropathic pain:
- Amitriptyline: proven to be effective in the treatment of central post-stroke pain (CPSP) in a placebo-controlled study 2, 3
- Lamotrigine: shown to be effective in reducing median pain score in patients with CPSP, with a dose of 200 mg/d being the most effective 3
- Gabapentin: reported to control CPSP in a few patients, and may be an effective medication for the treatment of central post-stroke pain syndrome 2, 4
- Gabapentinoids: recommended as first-line pharmacotherapy options for central post-stroke pain 5
- Duloxetine: shown to be effective in reducing pain severity in CPSP patients, with 70.3% of patients showing at least 30% reduction of Numeric Rating Scale (NRS) scores compared with baseline at the third week 6
Considerations for Treatment
When considering treatment options for post-stroke neuropathic pain, it is essential to evaluate the efficacy and safety profile of each medication. For example:
- Amitriptyline and lamotrigine have been shown to be effective in placebo-controlled studies, but may have side effects such as those associated with tricyclic antidepressants 2, 3
- Gabapentin and gabapentinoids may be effective for some patients, but their efficacy and safety profile may vary 2, 5, 4
- Duloxetine has been shown to be effective in reducing pain severity in CPSP patients, but may have side effects such as nausea, agitation, and somnolence 6