Anticonvulsants

Gabapentin and pregabalin act at the a28-subunit of presynaptic calcium channels on primary nociceptive endings.56,57 Dizziness and drowsiness are the most commonly reported adverse events, especially during upward titration to targeted doses. Both drugs have a low potential for drug interactions, and no negative impact on cardiac function. Peripheral edema occurs in some patients. Both drugs have been shown to be effective in the management of PHN. Pregabalin has superior bio-availability and...

Stimulation Techniques

Stimulation techniques, such as transcutaneous electrical nerve stimulation (TENS) and acupuncture may be effective for some people with neuropathic pain and may work by activating inhibitory mechanisms.89 V However, positive evidence of efficacy is limited, particularly with below-level neuropathic pain and most studies report a decline in efficacy over time (reviewed in Ref. 90 V ). Acupuncture appeared to have a sustained effect in 10 of 22 SCI patients with various types of pain, but was...

Antidepressants

Tricyclic antidepressants are widely used in the treatment of neuropathic pain and have been tested in both experimental and clinical conditions.67 I The mechanisms of action in pain relief are not completely understood, but it is assumed that antidepressants are especially effective in pain relief through the descending inhibitory serotoninergic nociceptive system.68 They inhibit pain transmission in the spinal cord by increasing levels of norepinephrine (NE) and serotonin (5-HT), as a result...

Safety

Carbamazepine and oxcarbazepine have similar dose-dependent adverse effect profiles (see Table 19.2). Gastrointestinal (nausea) and central (dizziness, vertigo, somnolence, fatigue, headache) side effects are common, but apparently less common and less severe with oxcar-bazepine.6 Allergic rash is relatively common and includes Stevens-Johnson syndrome and toxic epidermal necro-lysis. There is approximately 25 percent allergic cross-reactivity between carbamazepine and oxcarbazepine.6,12 Mild...

Differential diagnosis

Migraines in children generally present without aura prevalence of 70 versus 15 percent for migraine with aura . It is important to recognize some migraine syndromes which present more commonly in pediatrics, including ophthalmoplegic migraine third nerve paresis or palsy complex migraine transient neurological abnormalities basilar artery migraine Bickerstaff's migraine confusional migraine most common in adolescence, with aphasia and Alice-in-Wonderland syndrome headache with visual illusion...