Treatment of Neuropathic Pain

Nima Khoshnoodi, M.D., Michael Polydefkis, M.D., M.H.S., Brian Pinto, Pharm.D.
Treatment of Neuropathic Pain is a topic covered in the Johns Hopkins Diabetes Guide.

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INDICATIONS

FDA

  • Pregabalin for painful diabetic polyneuropathy (DPN)
  • Duloxetine for painful DPN

NON-FDA APPROVED USES

  • Gabapentin most commonly used non-FDA approved medication for DPN[4].
  • Non FDA-approved DPN pain medications include antidepressants, opiates or opiate-like agents and anti-epileptic medications.
  • Antidepressants include tricyclic antidepressants (amitriptyline, nortriptyline) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs: venlafaxine, duloxetine).
  • Antiepileptic medications include gabapentin, valproate, lamotrigine, carbamazepine, oxcarbazepine, phenytoin and lacrosamide.
  • Opiate or opiate-derivative agents include oxycodone, morphine sulfate, hydromorphone, fentanyl and tramadol.
  • Other agents include topical agents (lidocaine cream, lidoderm patches, capsaicin cream), neutriceuticals (Metanx, alpha-lipoic acid) and devices (spinal stimulators, transcutaneous electrical nerve stimulation).

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Last updated: July 8, 2018