Praktické lekárnictvo 2/2017

Treatment of neuropathic pain with a focus on opioids

Neuropathic pain is among difficult-to-treat pain conditions. Its occurrence in the population increases with increasing age. Anticonvulsants and antidepressants are the fundamental drugs in treating this pain. In case there is no adequate relief of pain, second-choice drugs are the next option, including, in particular, opioids, with some of them having a higher affinity to neuropathic pain. They particularly include oxycodone and tapentadol, with some papers also reporting buprenorphine. Treatment is always initiated with the lowest doses that are titrated to an effective dose. Currently, however, the ceiling effect of opioids is being applied that is equianalgesically equivalent to 160 mg of morphine daily. This dose should not be exceeded.

Keywords: neuropathic pain, opioids, capsaicin, lidocaine