Table 813 Sources of neuropathic pain

Anatomic conditions causing neuropathy

Entrapment neuropathy (carpal tunnel syndrome, ulnar entrapment, others) Trigeminal neuralgia Medical conditions causing neuropathy Diabetic neuropathy HIV-related neuropathy Malignancy Postherpetic neuralgia

Rheumatologic conditions producing neuropathy (rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus) Toxin-induced neuropathy Alcohol Arsenic Cisplatin

Dideoxynucleoside Paclitaxel Vincristine Guillain-Barre syndrome Fabry's disease Vasculitic neuropathy Amyloid neuropathy Idiopathic distal small-fiber neuropathy al. 2006; Galer 1995; Leo 2006). Treatment should be initiated early in the course of illness for optimal results (e.g., when amitriptyline is initiated within 3 months of developing the rash of herpes zoster infection, patients are less likely to develop the complications of postherpetic neuralgia) (Bowsher 1997). Restriction of and delays in the efficacy of TCAs in producing analgesia would be expected if they are administered after significant peripheral and central pathophysiologic mechanisms have set in. There are emerging data suggesting that anticonvulsants (e.g., pregabalin, gabapentin) may likewise have a preemptive analgesic role (Dahl et al. 2004). Other treatment interventions that may mitigate the pain experience include TENS, biofeedback, relaxation training, and hypnosis.

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