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best treatment for neuropathy
Aug 25, 2003

In your opinion, what is the best treatment for neuropathy?

Response from Dr. Conway

I can sure tell you the WORST treatment...NARCOTICS. Their efficacy for the control of neuropathic pain is uncertain at best, and they carry a definite risk of addiction for some people, so BE CAREFUL.

Assuming that the problem is truly neuropathy and not something else, the watchword is simplest is best. Rather than adding drugs, changing treatment to avoid the offending agent (such as didanosine or stavudine) is probably the best first approach. If this is not possible or does not solve the whole problem, non-steroidal agents or acetominophen could be tried. Beyond this, the agents with which there has been the most success are gabapentin, amytriptiline and carbamazepine. One common problem I see is a failure to use high enough doses of gabapentin (you can go up to 1500 mg tid, in my experience).

If narcotics are to be used, it should be done for a SHORT period of time with a CLEAR endpoint.



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