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About Nerve Treatments

Posted by Dorothy on 11/19/03 at 19:49 (138012)

Read this recently and hope it might be of use:
Guidelines Help Doctors Treat Nerve Pain
Wed November 19, 2003 06:58 PM ET

By Karla Gale
NEW YORK (Reuters Health) - New guidelines just released should help doctors treat patients with nerve pain, according to a report in the Archives of Neurology.

The report indicates that five drug types are suitable first-line treatments for nerve pain: opiates, tricyclic antidepressants, gabapentin, topical lidocaine and tramadol.

And when medication fails to relieve symptoms, surgical treatments are increasingly successful, Dr. Cole A. Giller maintains in a second report in the Archives.

Nerve, or 'neuropathic,' pain arises from disease or injury to one or more nerves. This contrasts with other types of pain in which the nerve itself is not damaged, but simply transmits the pain message from an affected body part to the brain.

Dr. Charles R. Argoff, from New York University Medical School, and colleagues reviewed published information to develop treatment recommendations for patients with neuropathic pain.

'Patients in pain have to be recognized and treated as assertively and as appropriately as soon as possible' to increase the likelihood that treatment will be successful, Argoff told Reuters Health. When deciding on treatment, doctors should consider a medication's benefits, cost, side effects, ease of use, and interaction with other drugs.

Up to 50 percent of primary care doctors consider nonsteroidal anti-inflammatory drugs (NSAIDs), an appropriate first line treatment for neuropathic pain. But 'NSAIDs are not effective for this type of pain, and they pose a significant risk for side effects,' Argoff said.

One option is opiates. 'Old teachings that neuropathic pain is resistant to opiates is nonsense,' Argoff said. When an opiate is used as treatment for medical conditions, 'it is extraordinarily unlikely that the patient will become a drug addict.'

Topical lidocaine and tramadol are also possible options, he added.

If a doctor isn't comfortable with treating neuropathic pain, Argoff advises referral to 'a neurologist, an anesthesiologist, or a podiatrist, anyone with skill in pain assessment, diagnosis and treatment.'

In his article, Giller outlines the major surgical treatments for neuropathic pain. Electrical stimulation of the spinal cord or brain often precedes procedures designed to destroy certain nerves. Another option is to set up a device that delivers drugs directly into the spinal canal.

SOURCE: Archives of Neurology, November, 2003.