Managing Chronic Pain: Practical Considerations to Improve Treatment Outcomes - Episode 14

Treatment Options Vary With Sources of Pain

In this segment, the panelists discuss the challenges of medication selection when it comes to treating patients with neuropathic pain. Specifically, they discuss whether certain anticonvulsants are better suited for treating specific forms of neuropathy, or whether clinicians should rotate through several options to find what works best for the patient.

Charles Argoff, MD, makes the point that it’s “not scientifically sound to say that every neuropathic pain state is the same,” noting that it’s likely that the mechanisms underlying various forms of neuropathy (such as painful idiopathic neuropathy and chemotherapy-induced neuropathy) are quite different. For example, he says

“Postherpetic neuralgia is both a peripheral and central mechanistically-based neuropathic disease, whereas trigeminal neuralgia is a totally different animal.”

Accordingly, the panelists also point out that although a medication may be approved by the FDA for treating specific indications, it doesn’t meant that it might not also be effective for others.

“I think many seasoned clinicians have developed a sense, based upon their review of the total literature and FDA approvals, to kind of know which medicines work in which settings,” Argoff notes. “FDA indication is great because it gives you a sense of where the drug has been studied, but it does take certain experience levels [to prescribe effectively] while also keeping in mind that no two neuropathic pain states are the same.”