Day 6- Neuropathic pain, muscle relaxant, fibromyalgia Flashcards
What are your risk factors for neuropathic pain?
What can increase neuropathic pain in diabetes?
What can increase neuropathic pain in HZV?
older age, female sex, manual occupation, unable to work, living in rural area, lower education.
Diabetes patients increase with poor control, smoking, hypertension, obesity, hypercholesterolemia, longer duration of diagnosis.
severe infection, increased age, immunocompromised individuals, initiation of antiviral therapy >1 month from disease from onset.
What are some causes of neuropathic pain?
Are TCA’s 1st line medications for neuropathic pain?
Are SSNRI’s 1st line medications for neuropathic pain?
Peripheral diabetic neuropathy, postherpetic neuropathy, chemo induced neuropathy (platniums, vinkas, alkaloids), HIV, spinal cord injury, surgery.
Yes! Big side effects are anti dumbbells. Use Nortriptyline, Despiramine. Administer at bedtime, titrate slowly, one pill daily.
Yes. Duloxetine. Big A/E is nausea and watch for renal and hepatic dysfunction. Can also use Venlafaxine(takes a while to titrate up), Cardiac side effects watch out for.
Can you use gabapentin/pregablin as 1st line medications for neuropathic pain?
What about topical lidocaine?
Can you cut lidocaine patches?
YES! Gabapentin require 2 month trial, pregablin works quicker.
YES! 1st line, local pain relief and not systemically absorbed. Does not work for central NP and local reactions.
Yes. Require a 12 hours holiday for efficacy.
What are second line agents for neuropathic pain?
What are third line agents for neuropathic pain?
Which anti spascity agent has a BBW for hepatotoxicity?
Opioids and tramadol. They can be used as first line in short term settings(acute NP, cancer related NP, exacerbations of severe NP).
Antidepressants and Antiepileptic, Topical Capsaicin.
Dantrolene.
Is there evidence to support the efficacy of one agent over another for muscle relaxants?
What are your antispasmodic and antispascitiy agents?
What are your antispascity agents?
NO!!!!
Tizanidine, Diazepam.
Baclofen, Dantrolene.
What is the triad of symptoms for fibromyalgia?
What are your recommended agents for fibromyalgia?
What do you avoid in fibromyalgia?
Pain, Disturbed Sleep, Fatigue.
Duloxetine/Milnaciprain and Pregablin.
Corticosteroids and opioids.
What are the risk factors for fibromyalgia?
Genetics, Female gender, stress, infections, sleep disorders, psychiatric conditions, rheumatic disease, chronic fatigue and irritable bowel syndrome.
