The American journal of managed care
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A large number of neuroanatomical, neurophysiologic, and neurochemical mechanisms are thought to contribute to the development and maintenance of neuropathic pain (NP). As a result, a corresponding wide range of treatments have been employed to treat patients with NP, including antiepileptic drugs, opioid analgesics, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, N-methyl-D-aspartate receptor antagonists, cholecystokinin receptor antagonists, adenosine, lipoic acid, cannabinoids, isosorbide dinitrate, dronabinol, capsaicin, protein kinase C inhibitors, aldose reductase inhibitors, and VR-1 receptor modulators. ⋯ At present, the only agents approved for the treatment of painful diabetic peripheral neuropathy and postherpetic neuralgia are lidocaine patches 5%, duloxetine, gabapentin, and pregabalin. Of these, only pregabalin is indicated for both conditions.
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Pain is the primary reason for patients seeking healthcare, and it has been estimated to result in more than dollar 100 billion per year in direct medical costs. Neuropathic pain (NP) alone has been associated with an approximately 3-fold increase in use of healthcare resources. The indirect costs associated with chronic pain result from increased absenteeism and decreased productivity at work, and they also have been estimated to total dollar 100 billion each year in the United States. ⋯ Patients with chronic pain also have difficulty in initiating and maintaining sleep, and sleep deprivation has the potential to exacerbate pain. Sleep deprivation is also associated with both anxiety and depression, and both of these conditions can exacerbate sleep disturbances. Effective management of the patient with chronic pain, including NP, requires assessment and, if necessary, treatment of all comorbidities associated with this condition.