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. 2020 Jul 27;21(15):5330. doi: 10.3390/ijms21155330

Table 5.

Pharmacotherapies in use in neuropathic pain.

Drug Class Kind of Neuropathic Pain Effects Side Effects References
First-Line Drugs
Antidepressants -Tricyclic antidepressants (TCAs):
amitriptyline, nortriptyline, desipramine,
imipramine

-Serotonin-norepinephrine reuptake inhibitors (SNRIs):
Duloxetina
Venlafaxina
Painful diabetic neuropathy

Post-herpetic neuralgia

Post-stroke pain

Painful polyneuropathy

Low back pain
Inhibition the reuptake of serotonin and noradrenaline into the spinal synapses between nociceptors (or first-order neurons) and the spinothalamic neurons (or second-order neurons) Sedation
Heart problems Constipation Drowsiness
Light-headedness
Weight gain
Dry mouth
Nausea

(SNRIs less side effects than TCAs)
[76,77,78]
Anticonvulsants -Phenytoin

-Gabapentin

-Carbamazepine

-Oxcarbazepine

-Valproic acid
Lancinating pain and allodynia

Painful diabetic neuropathy

Trigeminal neuralgia

Post-herpetic neuralgia

Painful polyneuropathy

Low back pain
Reduction of neuronal excitability and local neuronal discharges, acting through sodium channel blockade or modulation of calcium channels Dizziness Somnolence

Skin reactions such as Stevens–Johnson syndrome

Leukopenia

Hyponatremia
[79,80,81,82]
Second- and Third-Line Drugs
Topical agents -Lidocaine

-Capsaicin

-Clonidine

-EMLA (eutectic mixture of local anesthetics)
Allodynia

Post-herpetic neuralgia

Chemotherapy-induced
peripheral neuropathy

Post-surgical and post-traumatic neuropathic pain
Block of voltage-gated sodium channels expressed by nerve fibers, responsible for the propagation of action potentials. Local irritation
Possible hypersensitivity
[75,83,84,85,86]
Opioids -Morphine

-Oxycodone,

-Hydromorphone

-Tramadol
Diabetic peripheral neuropathy

Post-herpetic neuropathy

Polyneuropathy

Phantom limb pain
Opioid receptors are coupled to calcium and potassium channels, block synaptic transmission, restricting the number of nociceptive stimuli Drowsiness
Nausea
Dependence Overdoses
[76,87,88,89]
Corticosteroids -Prednisone

-Desametasone
Allodynia

Spinal cord compression

Post-herpetic neuralgia
Inhibition of prostaglandin synthesis, reduction inflammation, vascular permeability and tissue edema Gastrointestinal disease
Psychiatric disorders
Electrolyte imbalances
Bone demineralization
[90,91]
Alternative non-pharmacologic therapies -Acupuncture

-Magnetic insoles

-Repetitive transcranial magnetic stimulation (rTMS)
Chemotherapy-induced peripheral neuropathy

Trigeminal neuralgia

Post-stroke pain

Post-herpetic pain
Local inhibition of nociceptive fibres;
stimulates blood flow to restore nerve damage.
Bruising
Infection
[92,93]