Management of Neuropathy Pain Medications
Using medication in the treatment of pain due to neuropathy is usually a protocol referred to as “rational polypharmacology.” Pain from neuropathy is complex, and so are the protocols individualized for each patient. A physician must not only be knowledgeable of the different medications used for different strategies, but must be aware of the augmenting properties of combining medications, including both beneficial and harmful effects.
Many drugs affect cardiac function, impacting blood pressure, heart rate, respiration, and electrolyte balance. Many drugs, especially those that manipulate neurotransmitters (the selective serotonin norepinephrine re-uptake inhibitors), can cause emotional changes and even provoke thought of suicide.
Drug-drug interaction is important to consider in any use of multiple medications. Two medications with sedating properties will have more than just twice the sedation. This can impact a person’s driving, employment, or functioning in general.
Side effects can emerge that are specific for the drug. Methadone, for instance, requires an electrocardiogram (ECG) to watch for a particular arrhythmia seen when it is used for either pain management or rehabilitation.
The benzodiazepines can cause an overdose when mixed with narcotics or initiate a seizure when stopped abruptly. Physicians know not to stop them abruptly, but this offers no protection from a patient simply running out of them; the education of the patient regarding this danger must be part of the management and treatment.
Other medications besides the opioids are potentially addictive. Barbiturates, anti-anxiety medications, and even some antispasmodic medications can be, so this is part of the patient’s education, as well.
The management and treatment of neuropathic pain, whether using only one medication or combinations of pain medications, require effective communication between the patient and his or her doctor. Immediate notification of side effects can sometimes make possible a life-saving medical intervention.