Neurológia pre prax 5/2020

Pharmacotherapy for neuropathic pain in adults

Neuropathic pain is a severe clinical symptom of many different conditions affecting peripheral and central nervous system. Cancerrelated and spondylogenic pain frequently has neuropathic component. Contrary to nociceptive pain, analgetics such as paracetamole or nonsteroid anti-inflammatory drugs are typically ineffective in neuropathic pain. All current foreign and Czech recommendations agree on the first-line treatment and partially on the other treatment lines. First line treatments include anticonvulsants, in particular α2δ subunit of voltage gated calcium channels ligands (gabapentin, pregabalin), serotonine-norepinephrine reuptake inhibitors (duloxetine, venlafaxine) and tricyclic antidepressants (amitriptyline). Further therapy includes opioids (especially oxycodone), other anticonvulsants and topical agents (capsaicine, lidocain), eventually Botulinum toxine type A. In some cases combined therapy is necessary.

Keywords: neuropathic pain, pharmacotherapy, guideline, antidepressive agents, anticonvulsants, opioids, side effects