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]