NEUROPATHIC PAIN

Neuropathic pain occurs as a result of damage to nerve tissue. There are two clinical kinds of neuropathic pain, both
elements may be combined:

  • Stabbing-type: pain in a nerve distribution with minimal pain in between (e.g. trigeminal neuralgia) but can occur with any nerve. Responds to Phenytoin
  • Paraesthesia dysaesthesiae, or burning-type pain: (e.g. post-herpetic neuralgia). Responds well to small doses of Amitriptyline

Management

Trigeminal neuralgia or stabbing-type pain
Acute phase

  • Carbamazepine initially 100 mg every 12 hours
    • Increase gradually by 200 mg every 2-3 days according to response, max 1200 mg
    • Causes white cell depression

Burning type pain (post-herpetic neuralgia, diabetic neuropathy)

  • Amitriptyline 12.5-25 mg at night or every 12 hours depending on response, max 50-75 mg