Current pharmacologic approaches to treating neuropathic pain

Most neuropathic analgesic medications have been introduced initially for other medical conditions. Anticonvulsants, local anesthetics, and antidepressants later were found to be effective in the treatment of neuropathic pain. Carbamazepine and the newer anticonvulsants such as gabapentin, lamotrigine, topiramate, and oxcarbazepine are being used as first-line or adjunctive therapy. The newer agents have less potential for drug interactions and a more favorable side-effect profile. Lidocaine administered systemically or topically is useful for some peripheral and central neuropathic pain conditions. The tricyclic antidepressants amitriptyline, nortriptyline, and desipramine have been shown to be effective for the management of neuropathic pain, independent of their antidepressant property. All of the available analgesics have considerable side effects, which necessitate careful titration. Future drug research may focus on developing medications specifically for neuropathic pain. These designer agents may have more desirable action without the unwanted side effects.