The use of antineuropathic medications for the treatment of chronic pain

Ivan Urits; Nathan Li; Kevin Berardino; Kimberly Aleen Artounian; Prudhvi Bandi; Jai Won Jung; Rachel J Kaye; Laxmaiah Manchikanti; Adam M Kaye; Thomas Simopoulos; Alan D Kaye; Monica Torres; Omar Viswanath

doi:10.1016/j.bpa.2020.08.007

The use of antineuropathic medications for the treatment of chronic pain

Best Pract Res Clin Anaesthesiol. 2020 Sep;34(3):493-506. doi: 10.1016/j.bpa.2020.08.007. Epub 2020 Aug 8.

Authors

Affiliations

¹ Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA. Electronic address: ivanurits@gmail.com.
² Medical College of Wisconsin, Wauwatosa, WI, USA.
³ Georgetown University School of Medicine, Washington, DC, USA.
⁴ University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
⁵ Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA.
⁶ Medical University of South Carolina, Charleston, SC, USA.
⁷ Pain Management Centers of America, Paducah, KY, USA.
⁸ Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA, USA.
⁹ Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
¹⁰ Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA.
¹¹ Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.
¹² University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.

PMID: 33004161
DOI: 10.1016/j.bpa.2020.08.007

Abstract

Chronic pain syndromes cost the US healthcare system over $600 billion per year. A subtype of chronic pain is neuropathic pain (NP), which is defined as "pain caused by a lesion or disease of the somatosensory system," according to the International Association for the Study of Pain (IASP). The pathophysiology of neuropathic pain is very complex, and more research needs to be done to find the exact mechanism. Patients that have preexisting conditions such as cancer and diabetes are at high-risk of developing NP. Many NP patients are misdiagnosed and receive delayed treatment due to a lack of a standardized classification system that allows clinicians to identify, understand, and utilize pain management in these patients. Medications like tricyclic antidepressants, serotonin-norepinephrine reuptake Inhibitor (SNRIs), and gabapentinoids are first-line treatments followed by opioids, cannabinoids, and other drugs. There are limited studies on the treatment of NP.

Keywords: SNRI; chronic pain; gabapentinoids; neuropathic pain; treatment; tricyclic antidepressants.

Publication types

Review

MeSH terms

Anticonvulsants / administration & dosage*
Antidepressive Agents, Tricyclic / administration & dosage*
Chronic Pain / diagnosis
Chronic Pain / drug therapy*
Chronic Pain / physiopathology
Gabapentin / administration & dosage
Humans
Neuralgia / diagnosis
Neuralgia / drug therapy*
Neuralgia / physiopathology
Pain Management / methods*
Serotonin and Noradrenaline Reuptake Inhibitors / administration & dosage*

Substances

Anticonvulsants
Antidepressive Agents, Tricyclic
Serotonin and Noradrenaline Reuptake Inhibitors
Gabapentin