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Drugs for neuropathic pain 

Drugs for neuropathic pain
Chapter:
Drugs for neuropathic pain
Author(s):

Sachin Rastogi

and Fiona Campbell

DOI:
10.1093/med/9780199642656.003.0048
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date: 23 May 2019

Neuropathic pain is defined as ‘pain arising as a direct consequence of a lesion or disease affecting the somatosensory system’. It is often contrasted with nociceptive pain which is associated with tissue injury or inflammation. Neuropathic pain exhibits certain clinical features that differentiate it from nociceptive pain. Neuropathic pain conditions in children are different from those in adults and include complex regional pain syndrome (CRPS), phantom limb pain, postoperative and post-traumatic neuropathic pain, and autoimmune and degenerative neuropathies, e.g. Guillain–Barré syndrome, Charcot–Marie–Tooth disease. However, a lack of randomized controlled trials in children means that evidence from adult studies guides pharmacological management of neuropathic pain in children, which is problematic as the aetiologies and mechanisms are different. In this chapter we propose an algorithm for drug therapy for neuropathic pain in children based on best available evidence, our clinical experience, and the safety of these drugs in paediatric practice. We suggest a step-wise approach incorporating first-, second-, third-, and fourth-line therapies that should be tried methodically according to effectiveness and side effects. Neuropathic pain in children, if identified and treated in a timely manner as part of an interdisciplinary framework, using multimodal strategies can be managed effectively.

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