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General Algorithm for Neuropathic Pain


NSAID with least adverse CV effects



Celecoxib (Celebrex)

Dosing, contraindications, safety profile.

100 mg PO BID

No effects on platelet function, similar CV profile and renal effects to other NSAIDS, More GI protection.

Do not use in patients with heart disease or for perioperative pain management.


Gabapentin Dose for neuropathic pain

100 mg PO BID X 1 week, then 100 mg PO TID, then increase by 100 mg per dose per week until at 300 mg TID


Lyrica (Pregabalin) Dose for neuropathic pain

25 mg PO QHS for 3 days then increase by 25 mg Q3d until at least 150 mg QHS increase up to 225 mg BID for fibromyalgia


Cymbalta (duloxetine) for neuropathic pain

Dosing, side-effects

Cymbalta (for pain below the waist): 30 mg daily for 2 weeks, then 60 mg daily.

S/E: Nx (resolves within 2 weeks). Take on full stomach (helps with nausea).


How much to reduce equianalgesic dose by when opioid rotating.

When opioid rotating, reduce dose by 25% (reduce by 70-90% when rotating to methadone, do not reduce when rotation to fentanyl patch).


Lowest dose of contins

MS Contin: 15 mg

Hydromorph contin: 3 mg

Oxycontin: 10 mg


Dosing opioids for breakthrough pain

  • 5-15% daily dose as breakthrough QID


1. Dose of morphine IV

2. Duration of action

0.1 mg/kg IV then 0.05 mg/kg IV Q3-5 min PRN until pain controlled

Duration: 3 hours


1. Dose of Dilaudid IV

2. Duration of action

0.0125 mg/kg IV then 0.006 mg/kg IV Q3-5 min PRN until pain controlled

Duration: 3 hours