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An international panel of researchers recommends that patients with neuropathic pain receive any of five first-line drugs for initial pain control: an opioid, tricyclic antidepressant, gabapentin, topical lidocaine, or tramadol.


Participants in the Fourth International Conference on the Mechanisms and Treatment of Neuropathic Pain reviewed published information to devise treatment recommendations for people with neuropathic pain. Their guidelines, published in the Archives of Neurology, also review sequential and combination therapy with first-line drugs and the benefits and risks of second-line medications (other anticonvulsant medications and antidepressants).


As many as 50% of primary care providers consider nonsteroidal anti-inflammatory drugs (NSAIDs) a first-line treatment for neuropathic pain, researchers report, even though NSAIDs aren't effective for neuropathic pain and carry a significant risk of adverse reactions. When choosing a drug, health care providers should consider its efficacy, cost, adverse effects, ease of use, and interactions with other drugs. Those who lack expertise in treating neuropathic pain should refer patients to another practitioner with skill in pain assessment and treatment, such as a neurologist or anesthesiologist.




Advances in Neuropathic Pain," Archives of Neurology, R. Dworkin, et al., November 2003.