What are the drugs used for neuropathic pain?

From the Guidelines

Drugs commonly used for neuropathic pain include anticonvulsants such as gabapentin (300-1200mg three times daily) and pregabalin (75-300mg twice daily), which work by blocking calcium channels to reduce nerve excitability, as recommended by the American Academy of Neurology 1.

Treatment Options

The following medications are considered effective for neuropathic pain:

• Antidepressants, particularly tricyclic antidepressants like amitriptyline (10-75mg at bedtime) and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (60-120mg daily) and venlafaxine (75-225mg daily), which increase levels of pain-inhibiting neurotransmitters 1.
• Topical agents like lidocaine patches (5%) or capsaicin cream (0.075%) for localized neuropathic pain, providing relief without systemic side effects 1.
• Opioids such as tramadol (50-100mg every 4-6 hours) may be considered in more severe cases, though they carry risks of dependence and should be used cautiously 1.

Treatment Approach

Treatment typically begins with a single agent at a low dose, gradually increasing until pain relief is achieved or side effects become limiting 1.

• Combination therapy using medications with different mechanisms of action may provide better relief with fewer side effects than high-dose monotherapy.
• Treatment response should be monitored regularly, with adjustments made based on efficacy and tolerability 1.

Key Considerations

When selecting a medication, consider the patient's medical history, potential side effects, and the risk of dependence or interactions with other medications 1.

• Regular monitoring and adjustments to the treatment plan can help optimize pain relief and minimize adverse effects.

From the FDA Drug Label

Pregabalin is indicated for: Management of neuropathic pain associated with diabetic peripheral neuropathy Management of postherpetic neuralgia Adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older Management of fibromyalgia Management of neuropathic pain associated with spinal cord injury The drug used for neuropathic pain is pregabalin (PO), specifically for:

• Diabetic peripheral neuropathy
• Postherpetic neuralgia
• Spinal cord injury 2

From the Research

Drugs Used for Neuropathic Pain

The following drugs are used to treat neuropathic pain:

• Antidepressants:
  • Tricyclic antidepressants (e.g., amitriptyline) 3, 4, 5, 6
  • Serotonin-noradrenaline reuptake inhibitors (e.g., duloxetine) 3, 4, 5, 6
• Anticonvulsants:
  • Gabapentin 3, 4, 5, 6, 7
  • Pregabalin 3, 4, 5, 6
• Topical lidocaine 3
• Opioids (second- or third-line treatment) 3, 4, 5

First-Line Treatments

First-line treatments for neuropathic pain include:

• Antidepressants (tricyclic antidepressants and serotonin-noradrenaline reuptake inhibitors) 3, 4, 5, 6
• Anticonvulsants (gabapentin and pregabalin) 3, 4, 5, 6

Second- and Third-Line Treatments

Second- and third-line treatments for neuropathic pain include:

• Topical lidocaine 3
• Opioids 3, 4, 5