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Pharmacological Approaches to Neuropathic Pain

Pharmacological Approaches to Neuropathic Pain. Differential Diagnosis. Pain of dental origin Oral soft tissue pain Temporomandibular joint pain Myofascial pain dysfunction Neuropathic pain. From: Bonica, “The Management of Pain”, 1990. Pain Fibers. C A  Changes in A.

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Pharmacological Approaches to Neuropathic Pain

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  1. Pharmacological Approaches to Neuropathic Pain

  2. Differential Diagnosis • Pain of dental origin • Oral soft tissue pain • Temporomandibular joint pain • Myofascial pain dysfunction • Neuropathic pain

  3. From: Bonica, “The Management of Pain”, 1990.

  4. Pain Fibers • C • A • Changes in A

  5. From: Dickinson & Fleetwood-Walker, Trends in Pharm. Sci. 20: 324, 1999.

  6. Pain of Dental Origin • Physical findings • Pulpal and periodontal pain • Mucosal and other soft tissue pain • Radiographic findings • Nature and excitatory causes of pain

  7. Treatment of Dental Pain • Operative or surgical intervention • Drug treatment • Anesthetics • NSAIDS • Opioids

  8. Temporomandibular Joint dysfunctions • Disorders of muscles of mastication(myofascial pain dysfunction) • Internal joint derangement • Degenerative joint disease • Fractures, infections, tumors

  9. Treatment of Myofascial Pain Dysfunction • Non-drug treatment • Drug treatment • NSAIDS, Opioids • Tricyclic antidepressants (amitriptyline) • Centrally-acting muscle relaxants • Glucocorticosteroids

  10. From: Bonica, “The Management of Pain”, 1990.

  11. Neuropathic Pain • Pain in absence or in addition to nociceptive component • Example – trigeminal neuralgia • Characteristics of pain

  12. From: Bonica, “The Management of Pain”, 1990.

  13. Treatment of Neuropathic Pain • Surgical • Drug therapy

  14. From: Bonica, “The Management of Pain”, 1990.

  15. Carbamazepine Phenytoin Baclofen Gabapentin Tricylic antidepressants Local anesthetics Ketamine Clonazepam Drug Therapy (Neuropathic Pain)

  16. Experimental Drug Therapy for Neuropathic Pain • N-type calcium channel blockers • 2-adrenoceptor agonists (clonidine) • NMDA receptor antagonists • Selective serotonin reutake inhibitors • Adenosine receptor agonists • Valproic acid

  17. Tricyclic Antidepressants • Inhibit reuptake of catecholamines and serotonin • Block NMDA receptors • Release endogenous opioids • Peripheral action

  18. Carbamazepine (Tegretol) • Blocks sodium channels • Increases the release of catecholamines, thus indirectly stimulating 2-adrenoceptors

  19. Baclofen (p-Chlorophenyl GABA) (Lioresal) • Inhibits the release of excitatory neurotransmitters • A GABAB receptor agonist

  20. Valproic Acid (Depakene) • Increases GABA synthesis • Blocks sodium channels • Inhibits T (low threshold) calcium channels

  21. Gabapentin (Neurontin) • Binds to Gabapentin-binding protein • Blocks calcium channels • Increases GABA synthesis • Reduces glutamate

  22. Ketamine (Ketalar) • An NMDA receptor antagonist

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