Definition - pain related to neurological dysfunction, such as brain, spinal cord, peripheral nerve damage - can be made worse by chronic opioid exposure
Gabapentin (Neurontin)... Calcium channel blocker which reduces the release of nociceptive neurotransmitters in the spinal cord.  The half-life is 5-7 hours so qid dosing is recommended.  Taper up to a dose of 800mg pill qid with 1/2 tab later at night prn.  The prn 1/2 dosing at night gives patients a sense of control. (Argoff, 2003)
Pregabalin (Lyrica)100mg tid has the same method of action as Gabpentin but has better bioavailability.
Nortriptyline (Pamelor) to 150 q night, or duloxetine (Cymbalta) up to 60mg/day (good for OA pain).  These medications are SNRIs. Blocking reabsorption of serotonin and more so, norepinephrine, helps stimulate the brain’s own pain inhibitory pathways.  The higher doses help better with pain and may help depression. (Argoff, 2003)
Lidocaine- topical– 5% ointment/cream, 2% gel, 3% cream;  Note - 5% patch (Lidoderm) is non-formulary - can prescribe 5% cream and<unk>  Seran wrap to cover the area
OVMC:Pain and Substance Use Disorder
SCVMC:Onboarding
Harbor Macros: AMA
Harbor Macros: Back Pain
Harbor Macros: Abdominal Pain
SCVMC:CUSTODY CARE
Harbor Macros: Chest Pain
Harbor Macros: Pediatrics