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Chronic Neuropathic Pain

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Despite the availability of new drug therapies, neuropathic pain (NP) continues to pose challenges to patients and practitioners alike. It is often chronic in nature and, in a substantial number of patients, is not relieved by medication. Consequences include diminished mobility and function, lack of sleep, depressed mood, and impaired relationships with family and friends. The full medical and societal burden of NP isn’t clear; however, medical costs are estimated to be 3 times higher than those of patients without NP. The loss of patients’ and/or caregivers' ability to work and the need for additional assistance with tasks of daily living are major societal costs.

The prevalence of NP is unknown; estimates place it as low as 1% and as high as 10% in the general population. NP is most commonly seen in patients with diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), radiculopathies (e.g., spinal nerve compression that causes pain in the legs or arms), and nerve trauma.

The mainstay of treatment for most types of NP consists of antidepressants, anticonvulsants, topical anesthetics, and opioid analgesics. Only a handful, however, have been FDA approved: gabapentin (Neurontin®, Gralise®), lidocaine 5% patch (Lidoderm®), and capsaicin 8% patch (Qutenza®) for PHN; duloxetine (Cymbalta®) and extended-release tapentadol (Nucynta® ER) for DPN; and pregabalin (Lyrica®) for PHN and DPN. In order to achieve clinically meaningful pain relief, patients commonly require more than one type of medication. Treatment is often complicated by coexisting health conditions, and current guidelines recommend a highly individualized approach to management. Community practitioners can play a key role in helping patients optimize drug therapy and minimize the consequences of NP. This issue briefly reviews NP and the medications recommended for treatment, with a focus on the treatment of DPN and PHN, the most thoroughly studied types of NP.


Publication Date: 11/18/2012
Expiration Date: 11/18/2015
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Pamela Mausner, MD, Tracy Farnen, PharmD, and Emily Meuleman, MS, FNP-BC Contributing Editor: Lori Reisner, PharmD

Disclosure Statement

Dr. Mausner, Dr. Farnen and Ms. Meuleman report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe at least 4 common characteristics of neuropathic pain. Describe the risk factors and symptoms of DPN and PHN; discuss the relationship of neuropathic pain to these conditions.
    2. Name 4 antidepressants, 2 anticonvulsants, and 2 topical agents with evidence of efficacy in neuropathic pain. Discuss their roles in the management of neuropathic pain caused by DPN & PHN, and list the main adverse effects and drug interactions.
    3. Discuss the role of opioids (including tramadol and tapentadol) in the management of neuropathic pain.

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The Rx Consultant is a publication of Continuing Education Network, Inc.

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ACPE Universal Activity Number: 0428-0000-12-012-H01-P

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Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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