Traumatic Peripheral Nerve Lesions Medication

Updated: Dec 28, 2015
  • Author: Neil R Holland, MBBS, MBA, FAAN; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Medication

Medication Summary

As outlined in the text, a wide variety of analgesic medications may be effective in the treatment of neuralgic pain. These include both narcotic and nonnarcotic medications.

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Narcotic analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or injuries.

A review of opioid equivalents and conversions may be found in the following reference article:

 http://emedicine.medscape.com/article/2138678-overview

Fentanyl transdermal patch (Duragesic, Sublimaze, Abstral, Actiq, Duragesic, Ionsys, Lazanda, Onsolis, Subsys)

Potent narcotic analgesic with much shorter half-life than morphine sulfate. DOC for conscious sedation analgesia. Ideal for analgesic action of short duration during anesthesia and immediate postoperative period.

Excellent choice for pain management and sedation with short duration (30-60 min) and easy to titrate.

Easily and quickly reversed by naloxone.

After initial dose, subsequent doses should not be titrated more frequently than q3h or q6h thereafter.

When using transdermal dosage form, pain in majority of patients controlled with 72-h dosing intervals; however, some patients require dosing intervals of 48 h.

Oxycodone (OxyContin, Oxaydo, Oxecta, Roxicodone, Xtampza ER)

Relieves moderately severe to severe pain.

Morphine sulfate (MS Contin, Duramorph, Astramorph, Depodur, Infumorph, Kadian, MorphaBond, Avinza, Arymo ER)

DOC for analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various IV doses used; commonly titrated until desired effect attained.

For chronic severe pain unremitting to alternative therapy, oral immediate–release and extended-release morphine sulfate may be warranted. Arymo ER is a morphine sulfate abuse-deterrent formulation.

Methadone (Dolophine, Methadose, Methadose Sugar-Free)

Used in management of severe pain; inhibits ascending pain pathways, diminishing perception of and response to pain.

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Oral analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or injuries.

Tramadol (Ultram, Active-Tramadol, ConZip, EnovaRX-Tramadol, Rybix, ODT, Synapryn FusePaq)

Inhibits ascending pain pathways, altering perception of and response to pain; also inhibits reuptake of norepinephrine and serotonin.

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Tricyclic antidepressants

Class Summary

These agents are a complex group of drugs that have central and peripheral anticholinergic effects as well as sedative effects. They have central effects on pain transmission and block the active re-uptake of norepinephrine and serotonin.

Amitriptyline (Elavil)

By inhibiting re-uptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, may increase synaptic concentration in CNS.

Useful as analgesic for certain chronic and neuropathic pain.

Nortriptyline (Pamelor)

Has demonstrated effectiveness in treatment of chronic pain.

By inhibiting reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, may increase synaptic concentration in CNS.

Pharmacodynamic effects, such as desensitization of adenyl cyclase and down-regulation of beta-adrenergic receptors and serotonin receptors, also appear to play role in its mechanisms of action.

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Anticonvulsants

Class Summary

These agents are used to manage severe muscle spasms and provide sedation in neuralgia. They have central effects on pain modulation.

Gabapentin (Neurontin, Fanatrex FusePaq, Gralise, Gralise Starter)

Has properties common to other anticonvulsants and has antineuralgic effects. Exact mechanism of action not known. Structurally related to GABA but does not interact with GABA receptors.

Lamotrigine (Lamictal)

Triazine derivative used in neuralgia. Inhibits release of glutamate and inhibits voltage-sensitive sodium channels, leading to stabilization of neuronal membrane.

Follow manufacturer's recommendation for dose adjustments.

Pregabalin (Lyrica)

Structural derivative of GABA. Mechanism of action unknown. Binds with high affinity to alpha2-delta site (a calcium channel subunit). In vitro, reduces calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function. FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures.

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Anesthetics

Class Summary

These agents stabilize the neuronal membrane so the neuron is less permeable to ions. This prevents the initiation and transmission of nerve impulses, thereby producing the local anesthetic action.

Lidocaine anesthetic (ReadySharp Lidocaine, Xylocaine)

Several recent studies have advocated topical administration of lidocaine as treatment of PHN.

Lidocaine gel (5%) in a placebo-controlled study showed significant relief in 23 patients studied. Lidocaine tape also decreased severity of pain.

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