New neuropathy treatment guidelines.An expert panel has recommended five different kinds of drugs that are suitable for treating neuropathy pain in some patients. The review and recommendations were published in the November issue of Archives of Neurology The Archives of Neurology is a monthly professional medical journal published by the American Medical Association. Archives of Neurology publishes original, peer-reviewed scientific research of the nervous system as well as the various mechanisms of disease. (l). These guidelines mention HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. but are not HIV-specific. They are available free on the Web (at least when we checked on December 1, 2003) at: http://archneur.ama-assn.org/cgi/content/full/60/11/1524 From the article: "First-lineMedications. The efficacy of gabapentin, the 5% lidocaine lidocaine /li·do·caine/ (li´do-kan) an anesthetic with sedative, analgesic, and cardiac depressant properties, applied topically in the form of the base or hydrochloride salt as a local anesthetic; also used in the latter form as a patch, opioid analgesics Analgesics, Opioid Definition Opioid analgesics, also known as narcotic analgesics, are pain relievers that act on the central nervous system. Like all narcotics, they may become habit-forming if used over long periods. , tramadol hydrochloride tramadol hydrochloride Warning - High-alert drug! Dromadol (UK), Larapam (UK), Mabron (UK), Tramake (UK), Ultram, Ultram ER, Zamadol (UK), Zydol (UK) Pharmacologic class: Opioid agonist , and tricyclic antidepressants Antidepressants, Tricyclic Definition Tricyclic antidepressants are medicines that relieve mental depression. Purpose Since their discovery in the 1950s, tricyclic antidepressants have been used to treat mental depression. (TCAs) has been consistently demonstrated in multiple randomized controlled trials. Each one can be used as an initial treatment for neuropathic pain in certain clinical circumstances. Opioid analgesics and TCAs generally require greater caution than the other options. For each of these 5 medications, brief reviews of the relevant randomized clinical trials and specific treatment recommendations follow. Treatment recommendations are summarized in Table 2." Not recommended but sometimes used are NSAIDS; many experts believe they are not effective for this kind of pain. (However, AIDS Treatment News has heard anecdotal reports of relief with Voltaren Emulgel, an NSAID NSAID: see nonsteroidal anti-inflammatory drug. in a topical formulation. The topical form is not sold in the U.S., but may be available from Internet pharmacies for under $20. See our 1999 article at: http://www.aids.org/atn/a-321-01.html) The same issue of Archives of Neurology also has an article on surgical treatment for neuropathy pain(2), and an editorial(3). References (1.) Dworkin RH, Backonja M, Rowbotham MC, and others. Advances in Neuropathic Pain: Diagnosis, Mechanisms, and Treatment Recommendations. Archives of Neurology. November 2003; volume 60, number 11, pages 1524-1534 2. Giller CA. The Neurosurgicai Treatment of Pain. Archives of Neurology. November 2003; volume 60, number 11, pages 1537-1540. 3. Rosenberg RN. Pain 2003. Archives of Neurology. November 2003; volume 60, number 11, page 1520. |
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