Neurological Drug Therapy

Traditional analgesic medications like Paracetamol, Optalgin, and other non-steroidal anti-inflammatory medications fall short in alleviating nerve-related pain. Conversely, opioid narcotics like Morphine, Oxycodone, and Codeine are discouraged due to concerns about dependency and addiction. Neurogenic drug treatment for nerve pain is categorized into four groups:

• Gabapentinoids (e.g., gabapentin and pregabalin/Lyrica):
  • Frequently the initial choice for neuropathic pain, with pregabalin/Lyrica exhibiting the strongest scientific evidence in reducing such pain. Possible side effects include mood changes, nausea, dry mouth, and blurred vision.
• Tricyclic Antidepressants (TCAs) (e.g., amitriptyline/Elatrolet and nortriptyline/Nortiline):
  • Originally developed for treating depression in the 1970s, TCAs are now administered in low doses to diminish nerve sensitivity. Side effects may include dry mouth, dry eyes, constipation, urinary retention, restlessness, and confusion.
• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) (e.g., venlafaxine/Viepax and duloxetine/Cymbalta):
  • Primarily antidepressants, they are prescribed for pain in lower doses than for depression, often demonstrating pain reduction before improvements in mood. Potential side effects encompass nausea and increased blood pressure.
• Sodium Channel Blockers (e.g., carbamazepine/Tegretol, valproic acid/Depalept, and lamotrigine/Lamictal):
  • Commonly used for conditions like trigeminal neuralgia, epilepsy, and bipolar disorder. Associated side effects include liver disorders, pancreatic issues, obesity, allergic reactions, hematological changes, and movement disorders.

There is a considerable variability in individuals' responses to these four neurogenic drug families. As a general guideline, persisting with a drug for approximately six weeks (if tolerable side effects allow) is advised before assessing its effectiveness. The decision to continue, discontinue, or switch to a different family of drugs should be made based on this evaluation. Importantly, some patients suffer from a combination of pain sources, such as nerve pain alongside temporomandibular arthritis or myofascial muscle pain, necessitating a combined therapeutic approach.