Management of Neuropathic Pain

1. Management of
Neuropathic Pain
Presented By,
Dr. Sajid Hasan
MBBS (Army Medical College Chattogram)
MSE,MSD
ACI Limited

2. What is Neuropathic Pain?
Neuropathic pain is a pain condition that’s usually
chronic. It’s usually caused by chronic, progressive
nerve disease, and it can also occur as the result of
nerve injury or infection.

3. Etiology
Neuropathic pain can be caused by diseases:
 Diabetes (Diabetic Peripheral Neuropathy – DPN)
 Shingles (Post Herpetic Neuralgia – PSN)
 Spinal Cord Injury (SCI)
 HIV infection or AIDS.
 Central nervous system disorders (stroke, Parkinson’s
disease, multiple sclerosis, etc.)
 Multiple myeloma.
 Multiple sclerosis.

4. Etiology cont.….
Other causes include:
 Chemotherapy drugs (cisplatin, paclitaxel, vincristine, etc.).
 Radiation therapy.
 Amputation, which can cause phantom pain.
 Spinal nerve compression or inflammation.
 Trauma or surgeries with resulting nerve damage.
 Nerve compression or infiltration by tumors.

5. What are the symptoms?
 Shooting, burning, or stabbing pain.
 Tingling and numbness, or a “pins and needles” feeling.
 Spontaneous pain, or pain that occurs without a trigger.
 Evoked pain, or pain that’s caused by events that are
typically not painful — such as rubbing against something,
being in cold temperatures, or brushing hair.

6. Symptoms Cont.…
 A chronic sensation of feeling unpleasant or abnormal.
 Difficulty sleeping or resting.
 Emotional problems as a result of chronic pain, loss of
sleep, and difficulty expressing how you’re feeling.

7. Diagnosis of Neuropathic pain
Diagnosis is mainly clinical.
Following tests are also helpful in diagnosing the disease.
 Nerve function tests.
 Blood tests.
 Imaging tests.
 Nerve biopsy.
 Skin biopsy

8. Management & Treatment
of Neuropathic pain
The goals of treatment are to:
 Treat the underlying disease (for example, radiation or
surgery to shrink a tumor that is pressing on a nerve).
 Provide pain relief.
 Maintain functionality.
 Improve quality of life.
 Multimodal therapy (including medicines, physical therapy,
psychological counseling and sometimes surgery) is usually
required to treat neuropathic pain.

9. Drug Treatment
Medicines commonly prescribed for neuropathic pain include
anti-seizure drugs such as:
 Pregabalin
 Gabapentin
 Topiramate
 Carbamazepine

10. Pregabalin – an effective remedy
of neuropathy (DPN, PHN, SCI)
How it works?
 Pregabalin works by changing the way that nerves send
messages to brain. If the messages are reduced, then the
pain will be reduced. Normally, the starting dose is small and
may be taken between one and three times a day, but the
dose will be gradually increased.

11. Challenges of pregabalin in
treating neuropathic pain
There are some challenges in using Pregabalin Capsule in
neuropathic pain management. Such as-
 Pregabalin oral capsule (BD) can cause:
- Dizziness
- Sleepiness or Somnolence
- Blurry vision.
 It may affect the ability to think, see, or move.

12. Cont.…
The other commonly facing challenges of pregabalin can
include:
 Trouble concentrating
 Dry mouth
 Weight gain
 Swelling of hands or feet (rare)
 Recurrence of symptoms

13. How to overcome the
challenges?
There are many possible ways of overcoming the challenges &
barriers of administrating pregabalin in treating DPN & PHN-
1) By consistent & sustained release of the drug.
2) Administrate the whole drug by a single dose.
3) Take the very first dose at bedtime.
4) Gradually increase the dose or withdrawal of the drug by a
tapering dose.

14. Take Home messages
 Chronic neuropathic pain is a disease, not a symptoms.
 “Rational” polypharmacy is often necessary
- Combining peripheral & central nervous system a
agents enhances pain relief.
 Treatment goals include:
- Balancing efficacy, safety & tolerability
- Reducing baseline pain & pain exacerbations
- Improving activity of day to day life.
 New formulation of drugs & new uses for existing agents
offers additional treatment options.